Sertraline in the Treatment of Neurotic Excoriations and Related Disorders

Abstract

Self-injurious behavior directed at the skin has been described under various headings as follows: neurotic excoriations (NEs), acne excoriée des jeunes filles, compulsive skin picking, dermatitis autophytica, and others, while more severe forms are designated dermatitis artefacta, delusions of parasitosis, dermatitis factitia, and dermatopathic Munchausen's syndrome. Patients with the latter forms characteristically lack insight into their skin problem, may be psychotic, and either deny inflicting the skin lesions on themselves or give bizarre reasons for doing so. Patients with NEs often do not fit neatly into a psychiatric diagnostic category and may not even have a psychiatric diagnosis. Because NEs may be linked to a spectrum of obsessive-compulsive disorders¹and because antidepressant serotonin reuptake inhibitors (SRIs) such as fluoxetine, used to treat obsessive-compulsive disorder, have been shown to ameliorate self-excoriation in isolated case reports,^2,3we treated 31 patients (26 with NEs, four with acne excoriée, and one with intractable