Excoriation Disorder

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DESCRIPTION

Excoriation or skin picking disorder (ExD) is recurrent picking at one’s skin to the point of causing skin lesions or recurrent bleeding. Skin picking causes clinically significant distress or functional impairment, is accompanied by repeated efforts to stop or reduce the picking, and is not due to another mental disorder or a general medical or dermatologic condition.

EPIDEMIOLOGY

  • Although ExD can occur in children aged <10 years and in adults, the typical onset is in adolescence between ages 13 and 15 years.
  • ≥75% of individuals with ExD are female.

RISK FACTORS

ExD is more common in individuals with obsessive-compulsive disorder (OCD) and obsessive-compulsive–related disorders (OCRDs).

Genetics

  • A study of >5,400 female twins suggests that the heritability of ExD is ~47% and that it has substantial genetic overlap with trichotillomania (TTM), also known as hair pulling disorder, and together referred to as body-focused repetitive behaviors.
  • Approximately 15% of genetic risk for ExD is shared with other obsessive-compulsive and related disorders.
  • No specific genes have been implicated for ExD.

COMMONLY ASSOCIATED CONDITIONS

  • Localized infections, abscesses, and scarring; in severe cases, septicemia can occur.
  • Psychiatric comorbidity is common (seen in 20–50% of adolescents with ExD) and includes the following:
    • Mood disorders
    • Anxiety disorders
    • Body dysmorphic disorder
    • OCRDs
    • Substance use disorders
  • Skin picking typically begins earlier in childhood than any of the associated psychiatric comorbidities.
  • Patients may also engage in nail-biting, hair-pulling, or other pathologic grooming behaviors.

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