Excoriation Disorder, also known as Skin Picking Disorder, is characterized by the repetitive and compulsive scratching or picking of skin, which causes tissue damage. Patients spend a significant amount of time each day picking their skin, that causes psychosocial impairment. Triggers to pick vary greatly. For example, stress, anxiety, boredom, and feeling tired or angry have all been reported as triggers. Co-occurring psychiatric conditions are common in this disease. The most commonly reported comorbid conditions are trichotillomania, substance dependence, major depressive disorder, anxiety disorders, obsessive compulsive disorder (OCD), and body dysmorphic disorder (BDD). So far, there is no clear neurobiological explanation for the etiology of this disease. Recent research showed bilateral abnormalities in the anterior cingulate cortex and abnormalities on the left temporoparietal junction. Another study has shown deficits in motor inhibition, which appears to be correlated with frontal cortex abnormalities. Furthermore, severity of excoriation disorder may be associated with higher levels of impulsivity. Treatment for this disease has largely focused on cognitive behavioral therapy and pharmacology. Early psychosocial treatment studies provided evidence for skin picking reduction with habit reversal or acceptance-enhanced behavior therapy (AEBT). The data for selective serotonin reuptake inhibitors (SSRIs) efficacy in this disease are not convincing, although some studies suggested that fluoxetine is effective. Tricyclic antidepressants, neuroleptics, and the dopamine-blocking opioid antagonist have also been found to be effective for skin-picking.
In the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), excoriation disorder has been subsumed into the obsessive-compulsive disorders and related disorders (OCDRD) category.
