Excoriation disorder
Synonyms and keywords:  Compulsive skin picking; CSP; dermatillomania; neurotic excoriation; psychogenic excoriation

# Overview
Excoriation disorder (also known as dermatillomania, compulsive skin picking, neurotic excoriation, psychogenic excoriation, or  CSP) is an impulse control disorder and form of self-injury characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused. Excoriation disorder may be related to body dysmorphic disorder (BDD).
Sufferers of dermatillomania find skin picking to be stress relieving or gratifying, though it can still be as physically painful as it would be for a non-skin picker.

# Historical Perspective
- Lous-Anne-Jean Brocq was the first person to mention excoriation disorder on paper. She used the term in 1898 to describe a patient who uncontrollably picked their acne.

# Classification
- The DSM-5 changed excoriation disorder's classification from "impulse control disorder" to "excoriation (skin-picking) disorder.
- Excoriation disorder was originally known as "dermatillomania" before the DSM-5.
- The inability to control the urge to pick is similar to trichotillomania. Recent research suggests that, like trichotillomania, dermatillomania may be an impulse control disorder.  This is part of the obsessive compulsive disorder spectrum.
- In some animal models, it has been shown that animals that who excessively pull their hairs have more endorphin receptors in their brain than animals who do not. Endorphin receptors enable endorphins to have an effect on the brain. If this is true for humans, people who are particularly compulsive about their repetitive habits may have more endorphin receptors in their brain as well. This may explain why sufferers get more enjoyment out of picking their scabs than others.

# Pathophysiology
- Those suffering from excoriation disorder have very damaged skin, as a result of picking at it constantly.

# Differential Diagnosis
Excoriation disorder must be differentiated from:
- Neurodevelopmental disorders
- Prader-Willi syndrome
- Tourette's disorder
- Other obsessive-compulsive and related disorders
- Body dysmorphic disorder
- Other disorders
- Other medical conditions
- Acne
- Scabies
- Psychotic disorder
- Delusion
- Tactile hallucination
- Somatic symptom and related disorders
- Factitious disorder
- Substance/medication-induced disorders
- Cocaine

# Epidemiology and Demographics

## Prevalence
- The prevalence of excoriation (skin-picking) disorder is approximately 1,400 per 100,000 (1.4%) individuals worldwide.
- About 2% of dermatology patients suffer from excoriation disorder.

## Age
- The age of onset for excoriation disorder is likely either under 10 years old or between 30 and 45 years old.

# Risk Factors
Common risk factors in the development of excoriation disorder include:
- Genetic predisposition
- Obsessive-compulsive disorder(OCD)

# Natural History, complications, and prognosis

## Natural History
- The symptoms of excoriation disorder usually develop either under 10 years of age or between 30 and 45 years old.

## Complications
- There are no known complications associated with excoriation disorder.

## Prognosis
- Those who suffer from this disorder tend to wear long sleeved clothing, even in warm weather, to hide any damaged skin. They are hindered by embarrassment when going out in public. If excoriation disorder is left untreated, it can last as long as 21 years.

# Diagnostic Criteria

## DSM-V Diagnostic Criteria for Excoriation (Skin-Picking) Disorder 

# History and Symptoms
- History of picking at the the skin
- History of personal issues such as abuse that may lead to these behaviors.
- Acne already preexisting on the body.

# Laboratory Findings
- There are no diagnostic laboratory findings associated with excoriation disorder.

# Other Imaging Studies
- There are no other imaging findings associated with excoriation disorder.

# Other Diagnostic Studies
There are no other diagnostic studies associated with excoriation disorder.

# Medical Therapy
- SSRIs, glutamateric agents, and opioid antagonists can all help in treating excoriation disorder.
SSRIs are effective in treating obsessive-compulsive disorder, which is closely related to excoriation disorder.
- SSRIs are effective in treating obsessive-compulsive disorder, which is closely related to excoriation disorder.
- Skin picking, which is the defining symptom of excoriation disorder, can be treated by using antidepressant, anti-anxiety, anti-epileptic, and antipsychotic medications.

# Psychotherapy
- Habit reversal training, acceptance and commitment therapy, acceptance-enhanced behavioral therapy, and cognitive behavioral therapy were all used to help treat excoriation disorder.
- These strategies help reduce skin picking behavior in individuals with excoriation disorder, but no psychological issues.

# Brain Stimulation Therapy
- There is no brain stimulation therapy associated with excoriation disorder.

# Cost Effectiveness of Therapy

# Future or Investigational Therapies