Skin Picking Research Articles

Yale-Brown Obsessive Compulsive Scale modified for neurotic excoriation: Validity and reliability study of Turkish version

Yale-Brown Obsessive Compulsive Scale modified for neurotic excoriation: Validity and reliability study of Turkish version

经络环皮部挑治法结合归智丸治疗老年记忆障碍10例疗效分析

经络环皮部挑治法结合归智丸治疗老年记忆障碍10例疗效分析

The Efficacy of Risperidone on the Treatment of Very-Early Onset Skin Picking Disorder

Skin picking disorder (SPD) has frequently been reported to start before the age of 10; but “very-early onset” type was not defined before in the literature. Also research on the treatment of SPD in childhood is limited. We presented a “very-early onset” SPD case whose symptoms have started on the age of 4 and escalated with her comorbid oppositional defiant disorder diagnosis. Patient was successfully treated with low dose (0.25 mg/day) risperidone and proper psychoeducational interventions. Identifying SPD in very early childhood is hard cause; criterion of SPD might not capture all the specific features which very young children manifest and clinicians might overlook their complaints. Efficacy of risperidone might reflect a shared psychopathological etiology between impulse control and SPD, and lead future research on treatment of SPD with atypical anti-psychotics.

Visual Triggers of Skin Picking Episodes: An Experimental Study in Self-Reported Skin Picking Disorder and Atopic Dermatitis.

Skin Picking Disorder (SPD) is a new diagnosis with limited information available about triggers of picking episodes. Itch can be induced via audio-visual stimuli and the effect of contagious itch is stronger for those affected by atopic dermatitis. We examined if picking-related visual stimuli can trigger the urge to pick skin in self-reported SPD. We compared itch and the urge to pick in a sample of AD and/or SPD-affected to controls without either. Urge to pick skin and/or scratch when viewing 24 itch-related, picking-related or neutral online pictures was assessed in adult females, who self-report skin-picking (SPD-only, n = 147) and/or atopic dermatitis (AD-only, n = 47; AD+SPD, n = 46) as well as in skin healthy controls (HC, n = 361). All participants reported a stronger urge to pick for picking-related pictures compared to neutral content (F[1, 597] = 533.96, p < .001, ηp2 = .472) and more itch for itch-related pictures compared to neutral stimuli (F[1, 597] = 518.73, p < .001, ηp2 = .465). SPD-all (SPD-only & AD+SPD) reported stronger urges to pick for picking-related vs. other stimuli compared to the AD-only and HC group (p < .001, ηp2 = .047). Likewise, AD-all (AD-only & AD+SPD) reported significantly stronger itching for itch-related vs. other stimuli compared to SPD-only and HC (p = .001, ηp2 = .019). Analog to visual provocation of itch, the urge to pick can be triggered by visual stimuli. Treatments for SPD and AD may profit from addressing visual stimuli.

The Spanish version of the Excoriation (Skin-Picking Disorder) Dimensional Scale (SPD-D): An assessment of its psychometric properties

BackgroundIn 2013, the DSM‐5 obsessive-compulsive spectrum disorders sub‐workgroup developed the Excoriation (skin‐picking disorder) Dimensional Scale (SPD‐D) as a dimensional assessment that enquires about excoriation disorder symptoms that have occurred over the past week. This study aimed to assess the psychometric properties of the Spanish version of the SPD‐D in a population sample from Paraguay. MethodParticipants were recruited through an Internet-based survey. Subjects included were individuals ≥ 18 years old, who self-reported a diagnosis meeting the criteria for excoriation disorder. 531 individuals were rated for the validation analysis. SPD-D was back-translated and validated into Spanish. Exploratory and confirmatory factorial analysis were performed. Participants were also assessed with the Skin Picking Scale-Revised (SPS-R). ResultsExploratory factorial analysis reported that only one factor had a raw eigenvalue greater than 1, and explained 57.4% of total variance. Thus, the scale is considered one-dimensional, as confirmed by confirmatory analysis. Fit indices suggest a good adjustment and Cronbach’s alpha showed good internal consistency (α=0.816). Good convergence was found between the scores of the SPD-D and the SPS-R (r=0.822, p<0.0001). ConclusionThe Spanish version of SPD-D shows good psychometric properties and adequately reproduces the one-dimensional model of the original English version.

Cross-sectional survey examining skin picking and hair pulling disorders during the COVID-19 pandemic

Cross-sectional survey examining skin picking and hair pulling disorders during the COVID-19 pandemic

A Case Report of Pemphigoid Nodularis as Masquerader of Neurotic Excoriations

Abstract Introduction: Pemphigoid nodularis is a rare clinical variant of bullous pemphigoid characterized by both prurigo nodularis-like lesions and pemphigoid-like blisters. Herein, we report a case of pemphigoid nodularis in a cognitively-impaired patient who has been managed as extensive prurigo nodularis with neurotic exocriations for many years. Case presentation: A 72-year-old Chinese man has been on follow-up at an outpatient Dermatology unit for extensive prurigo nodularis for past 4 to 5 years until an inpatient stay when he was admitted for labile mood and erratic behavior due to the intense pruritus and skin lesions. During the admission, the inpatient team noticed tense hemorrhagic blisters on his right thigh for which histological examination confirmed the diagnosis of bullous pemphigoid. He was treated with oral prednisolone, doxycycline, and nicotinamide, which led to clinical improvement. Discussion: Pemphigoid nodularis can be easily misdiagnosed as prurigo nodularis. We discuss clinical clues that can raise the suspicion of an underlying immunobullous disorder, including erythematous nodules with a much larger surface area affected by central erosions and ulceration. Pruritus associated with larger areas of erosions and ulceration is clues that lesions can be more than mere excoriations. Conclusion: It is important for clinicians to be aware of the presentation of prurigo nodularis in association with bullous pemphigoid such that effective treatment can be promptly instituted. This is especially illustrated in this case, as the treatment of bullous pemphigoid not only improved his skin condition but it also improved his psychological health and behavior with the resolution of itch.

Geriatric dermatosis; The concerns of aging skin.

Objectives: To study the cutaneous manifestations in elderly and their association with gender. Study Design: Cross Sectional study. Setting: Sir Syed Hospital Karachi. Period: Jan 2016 to Jan 2018. Material &amp; Methods: Total 217 geriatric cases (&gt;60 years; both genders) were included from outdoor dermatology clinic. The previous pregnancy, lactation, severe systemic disease and drug induced skin changes were excluded. The association of skin manifestation with gender was analyzed by Chi-square test with significant p&lt;0.05. Results: Among 217 cases, there were 126(58%) females and 91(42%) males. Mean age was 69.3+4.99 years. Wrinkling was seen in 92%, skin laxity in 54.8%, xerosis (43%), dryness (65%), sagging (46%), pigmentation (37%), eczema (25%), sparse hair (21%), skin atrophy (19%), tinea (13%) and LSC (10%). While herpes zoster, psoriasis, onychomycosis, tinea corporis ,asteotic eczema in 7%. Folliculitis 6%, scabies and bullous pemphigoid seen in 5%, while lichen planus, actinic elastosis, BCC, Prurigo nodularis in 3%. Cellulitis, pediculosis, Seborrheic Dermatitis and contact dermatitis were seen in 2% followed by 1% cases of warts, candidiasis, photodermatosis and SCC seen in our study. Folliculitis (6%) was the most frequent bacterial infection followed by impetigo (0.9%). Herpes zoster (6.5%) was frequent among viral infections followed by warts (0.9%) and HSV-1 (0.9%). Tinea (13.4%) was most frequent fungal infection followed by onychomycosis (7%) and candidiasis (0.9%). Scabies was most common parasitic infection (4.6%) followed by pediculosis (2.3%). Eczema seen in 24.8%. The benign dermatosis, Actinic elastosis was frequent (3.2%), stucco keratosis 4(1.8%), Keratoacanthoma (0.9%). Amongst malignancies, BCC was common (3.2%), followed by SCC (1.4%). 5% Bullous Pemphigoid cases were found. The psychocutaneous disorder included LSC (10%), prurigo nodularis (2.8%) and neurotic excoriation (0.9%). Wrinkling, sagging, dryness of skin, actinic keratosis, actinic elastosis was found to be associated with female gender, however cellulitis, squamous cell carcinoma and asteatotic eczema with male gender. Conclusion: Geriatric population is facing multiple dermatological concerns. Contributory factors being the natural aging process, exposure to UV radiation, pathogens, dryness, humidity, temperature and chemical irritants. Female geriatrics are prone to wrinkling, sagging, dryness of skin and male geriatrics to basal cell carcinoma. There is need to address the skin problems in elderly for better quality of life in geriatrics.

Identifying subtypes of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder using mixture modeling in a multicenter sample

Body-focused repetitive behavior disorders (BFRBs) include Trichotillomania (TTM; Hair pulling disorder) and Excoriation (Skin Picking) Disorder (SPD). These conditions are prevalent, highly heterogeneous, under-researched, and under-treated. In order for progress to be made in optimally classifying and treating these conditions, it is necessary to identify meaningful subtypes. 279 adults (100 with TTM, 81 with SPD, 40 with both TTM and SPD, and 58 controls) were recruited for an international, multi-center between-group comparison using mixture modeling, with stringent correction for multiple comparisons. The main outcome measure was to examine distinct subtypes (aka latent classes) across all study participants using item-level data from gold-standard instruments assessing detailed clinical measures. Mixture models identified 3 subtypes of TTM (entropy 0.98) and 2 subtypes of SPD (entropy 0.99) independent of the control group. Significant differences between these classes were identified on measures of disability, automatic and focused symptoms, perfectionism, trait impulsiveness, and inattention and hyperactivity. These data indicate the existence of three separate subtypes of TTM, and two separate subtypes of SPD, which are distinct from controls. The identified clinical differences between these latent classes may be useful to tailor future treatments by focusing on particular traits. Future work should examine whether these latent subtypes relate to treatment outcomes, or particular psychobiological findings using neuroimaging techniques.

A study of dermatological disorders with primary psychiatric illness from South India

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Dermatological disorders are frequent among patients with psychiatric illness. The interaction between skin and mind is complex. Pre-existing skin diseases may be modified in psychiatric illness due to self induced changes which may delay the diagnosis and treatment of skin diseases and result in complications. There are only few published studies about skin diseases in psychiatric patients from south India. We are undertaking this study to highlight the importance of dermatology consultation in psychiatric patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 200 patients with primary psychiatric disorders who accepted for the study were subjected to history taking and general examination. Detailed dermatological examination was carried out by visual inspection and clinical examination.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 200 patients, 65 were diagnosed with major depressive disorder, 42 patients were with bipolar disorder, 40 with schizophrenia, 30 with obsessive compulsion disorder, 23 with anxiety disorder. 153 (76.5%) patients had dermatological findings, in which 84 (55%) had infectious disease, 35 (22.9%) had parasitic infections, 26 (17%) had fungal infections, 15 (9.8%) had bacterial infections, 8 (5.23%) had viral infections. 56 (36.6%) had non-infectious skin findings, 22 (14.4%) had acne, 15 (9.8%) had pruritis, 12 (7.84%) had eczema, 5 (3.3%) had psoriasis and 2 (1.3%) had vitiligo. 13 (8.4%) patients had psychodermatological problems, 10 (6.53%) had neurotic excoriation, 2 (1.3%) had delusion of parasitosis and 1 (0.6%) had trichotillomania.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: This study implies that there is a definite association of dermatology and psychiatry.&lt;/p&gt;

Psychometric properties of the Spanish version of the Skin Picking Scale-Revised (SPS-R)

• Excoriation disorder is described as a recurrent picking of skin, leading to skin lesions and significant distress. • This is the first study to determine the psychometric properties of the Spanish version of the Skin Picking Scale Revised. • The Spanish version of the Skin Picking Scale Revised shows good psychometric properties. • The Spanish version of SPS-R adequately reproduces the two-dimensional model of the original scale.

Coronavirus Disease-19 Pandemic and Dermatology. What to Expect?

The novel coronavirus (CoV), CoV disease (COVID)-19, and the ongoing pandemic, is changing every aspect of the human life. Furthermore, the COVID-19 pandemic has a profound impact on health-care worldwide, with no exception in dermatology care units. At the time of pandemic, constant fear and stress are present on the surface. Skin diseases are the most common somatic causes of psychological disorders and, conversely. During a stressful situation, the body has power to adjust and to maintain its well-being, but with prolonged exposure to stress, the first negative changes such as fear, anxiety, and depression will eventually lead to chronic fatigue and an increased risk of disease. The proportion of patients reporting emotional triggers varies with the disease, ranging from approximately 50% in acne to 90% in rosacea, alopecia areata, psoriasis, neurotic excoriations, and lichen simplex and may be 100% for patients with hyperhidrosis. In this paper, we will look at the most common psychodermatological disorders and its implication in the era of COVID-19 pandemic. According to all the pathophysiological conditions that indicate the association of skin diseases with stress, it is normal to expect their deterioration and occurrence in this pandemic period. We will be witnessing a growing number in patients’ consultations with chronic urticaria, dermographism, worsening rosacea, generalization, and relapses of psoriasis. It is needed to be prepared for as many cases as possible, because the psychological consequences will still be felt. We encourage more comprehensive studies of the implications of the COVID-19 pandemic in these patients.

Epidemiology and Comorbidities of Excoriation Disorder: A Retrospective Case-Control Study.

Excoriation disorder is a psychocutaneous disorder characterized by repetitive skin-picking and associated with significant morbidity. Currently, epidemiological data in patients with excoriation disorder are lacking so we sought to characterize common patient demographics and comorbidities. We conducted a retrospective case-control study comparing 250 patients with excoriation disorder with 250 age-, race- and sex-matched controls identified between 2007 and 2019 at a single tertiary care center. We found that the majority of excoriation disorder patients were female (76%), Caucasian (82%) and unmarried (62%), with a mean age of 49 years. Compared to the matched controls, patients with excoriation disorder had increased odds of several psychiatric illnesses, including obsessive compulsive disorder (odds ratio (OR) 28.48, 95% confidence interval (CI): 1.68, 481.75), substance use disorder (OR 24.33, 95% CI: 5.81, 101.77), post-traumatic stress disorder (OR 8.23, 95% CI: 2.24, 129.40), depression (OR 8.19, 95% CI: 4.86, 13.80), bipolar disorder (OR 7.55, 95% CI: 2.22, 25.65), attention-deficit/hyperactivity disorder (OR 5.63, 95% CI: 1.62, 19.57), and anxiety (OR 5.01, 95% CI: 2.92, 8.62). Only a minority (42%) of patients were given psychiatry referrals and of those referred, a majority (64%) did not follow-up with psychiatry. The outcomes were also generally unfavorable as only 21% of patients experienced a resolution or improvement in their symptoms. This highlights the need for a multidisciplinary approach to manage patients with excoriation disorder, involving both dermatologists and psychiatrists.

Excoriation disorder vs skin-centered body dysmorphic disorder: A clinical and therapeutic update.

Skin-centered body dysmorphic disorder (BDD) and excoriation disorder (ED) are categorized under Obsessive Compulsive and Related Disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and are characterized by excessive or inappropriate skin picking. Patients with skin-centered BDD and ED often first present to dermatology. These conditions are important to recognize and appropriately diagnose, as perpetuation of the disorder is inevitable without appropriate psychiatric treatment. These conditions are associated with increased morbidity and BDD is associated with increased suicide risk. This review aims to present a combined dermatologic and psychiatric approach to diagnosing, differentiating, and managing skin-centered BDD and ED. Patient presentation, DSM-5 criteria, and management approaches are reviewed.

Treatment of skin picking disorder: Interdisciplinary role of dermatologist and psychiatrist.

Skin picking disorder (excoriation disorder) is a common psychodermatological disorder characterized by irresistible urges to pick skin on dominant hand accessible parts of the body. There is no specific recommended treatment available. Various pharmacological agents particularly selective serotonin reuptake inhibitors and glutamatergic agents have been tried with variable success. Habit reversal therapy has been commonly employed in the treatment and has some evidence-based success. This review focuses on the interdisciplinary team approach consisting of a liaison with psychiatry, in the management of this disorder. The specific roles of dermatologist and psychiatrist are discussed in detail.

Case series of primary psychiatric skin disorders with multi-disciplinary approach

&nbsp; Background: The incidence of psychodermatologic diseases, a group of skin abnormalities associated with psychosomatic factor, are increasing recently. About 20-40% patients with skin symptoms have concurrent psychiatric problems which are often difficult to diagnose and treat. The new classification of primary psychiatric skin disorders are delusional disorders, obsessive-compulsive and related disorders, and factitious disorders. This classification could be used for effective treatment in each patient which involves multi-disciplinary approach, including dermatology, psychiatry and other discipline if necessary. Case Illustration: The first case was a 39-year-old unmarried female, with anemia and dermatitis artefacta occurred as wound due to blade cuts. Patient was with schizoaffective depressive type and was not under regular treatment. The second case was a 61-year-old male referred with unresolved prurigo nodularis for the past 30 years. After in-depth assessment, there were delusional parasitosis and neurotic excoriations disorders. The third patient was a 50-year-old female admitted with recurrent ulcer on her face. She was aware that the lesions were intentionally manipulated by her own fingers when she was depressed. Discussion: All patients were classified as primary psychiatric skin disorders with varied skin manifestations. Symptoms usually occurred when the patient was in the depression state or low compliance for the psychotropic drugs. Patients generally had poor insight and refused to be associated with psychiatric factors. Dermato-venereologists are expected to conduct early detection and treat this disease. Conclusion: It is important to approach psychocutaneous disease in multi-disciplinary manner, especially with the psychiatrist. Keywords: psychodermatologic, dermatitis artefacta, neurotic excoriations, delusion of parasitosis &nbsp;

467 Neurotic excoriations: A retrospective cohort study of disease presentation, comorbidities, and treatment in 250 patients at a tertiary care center

There is a lack of epidemiologic data on patients with neurotic excoriations (NE). We thus conducted a retrospective chart review of patients with NE from 2007 to 2019 at a tertiary care center. Patients with ICD-9/10-CM code L98.1 from January 1, 2007 to May 1, 2019 were identified (n=315). Patients (n=250) with the diagnosis of “neurotic excoriations,” “skin-picking,” “excoriation disorder,” or equivalent synonym were identified. Patient demographics, systemic and psychiatric comorbidities, clinical course, psychiatric medications, duration of symptoms, and outcome were collected. Average age at diagnosis was 49 years, the majority of patients were female (76%), Caucasian (82%) and unmarried (61%). The most common systemic comorbidities were Type II Diabetes (16.4%), thyroid dysfunction (11.6%) and hepatitis C (6.4%). A majority (74%) had at least one psychiatric comorbidity, the most common being depression (42%), anxiety (30%) and substance use disorder (16%). Only a minority of patients (45%) were given referrals to psychiatry and most patients (64%) did not follow-up with psychiatric care. Fifty-three patients (21%) experienced improvement of symptoms. The most common treatments consisted of topical/oral antibiotics (57%), topical corticosteroids (52%), antihistamines (23%) and doxepin (17%). This is one of the first studies characterizing the population of patients affected by NE. The majority of our cohort were middle-aged, unmarried, Caucasian females with a high burden of psychiatric comorbidities Type II Diabetes. We demonstrate that despite a diagnosis of NE, only a minority of patients were seen by psychiatry. Further, treatment outcomes were generally unfavorable, highlighting the need for further research into the underlying pathophysiology and a multidisciplinary treatment approach.

Psychodermatology of skin picking (excoriation disorder): A comprehensive review.

Excoriation disorder (ED) is a primary psychiatric disorder characterized by recurrent skin picking, which may lead to self-induced cutaneous lesions and significant distress or functional impairment. The affected patient is aware of his/her self-destructive behavior but feels unable to give up this habit, despite having made repeated attempts to decrease or stop it. ED is a relatively frequent disorder, of notable heterogeneity and phenomenological complexity, accompanied by significant emotional and physical consequences. Therefore, further research is necessary to enhance the knowledge on its clinical manifestations, epidemiology, and comorbidities. This article presents an update regarding the etiopathogenesis, clinical aspects, and treatment options of ED to provide an up-to-date review for psychiatrists, dermatologists, and general practitioners.

Cognitive behavioral therapy as an adjuvant therapy in acne excoriée: a randomized controlled clinical trial

Background Acne excoriée (AE) is a difficult challenge in dermatology practice. AE is mostly associated with some psychiatric disorders particularly mood disorders. Thus, patients generally continue to manipulate their lesions. It was aimed to compare the effectiveness of cognitive behavioral therapy (CBT) as an adjuvant treatment for AE in a randomized controlled clinical trial. Methods Thirty-two adults with AE were randomly assigned to CBT or control group. Both the groups received similar standard medication. Furthermore, eight sessions of CBT were held during 2 months in CBT group. Self-reported Skin Picking Scale (SPS), clinical severity rating, beck anxiety and depression inventories were determined at the baseline and after 2-month follow-up. Results Participants in CBT group showed significantly more improvement on clinical severity score (p=.01) as well as SPS score (p=.02) after 2-month follow-up, in comparison to the control group. Depression and anxiety scores were significantly diminished after two months among CBT group in comparison to controls (p value .01 for both anxiety and depression). Conclusion CBT constitutes a utile treatment option for AE and should be considered as an adjuvant therapy in clinical setting.

Skin Picking in People with Prader-Willi Syndrome: Phenomenology and Management.

Skin picking is highly prevalent in people with Prader-Willi syndrome (PWS). This study addressed the temporal (frequency, duration) and wider characteristics (e.g. type of skin picked, apparent motivations, or management strategies) of skin picking to inform intervention strategies. Nineteen parents/carers who observe skin picking shown by the person they care for completed a semi-structured interview. Results were consistent with previous research but advanced the field by finding that most participants picked skin with an imperfection and that parents/carers most commonly use distraction as a management strategy. Interventions that are behavioural, support emotion regulation and/ or are used in the typically developing population are therefore likely to be beneficial for future research.