Approach in the excoriation disorder: a developing field
DOI:
https://doi.org/10.25118/2763-9037.2023.v13.655Keywords:
excoriation disorder, dermatotillomania, disorder, skin pickingAbstract
Excoriation Disorder (ET), that is, the habit of causing skin lesions, usually on the face, causing functional impairment, is common in psychiatric psychopathology, but still infrequent in clinical practice. Less than 20% of patients with ET seek treatment. In this work, a bibliographic review was carried out on the proposed theme and possibilities of established approaches. The treatment of ET with Habit Reversal Therapy (HRT) is considered effective. This therapy is based on four techniques: awareness, competitive response practice, motivation and generalization. The main psychoactive drugs evaluated were Selective Serotonin Reuptake Inhibitors (SSRIs), with controversial results. Another approach that also addresses the reversal of habits is the Rothbaum Protocol (RP), which associates stress management with management. Unlike HRT, PR addresses co-occurring depressive and anxious symptoms. There is still some disagreement regarding the treatment of Excoriation Disorder. Therapies with greater applicability show better results for changing intrinsic habits. Psychotropic drugs for impulse control corroborate with greater awareness and, consequently, avoidance of symptoms.
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References
Gupta MA, Gupta AK. Current concepts in psychodermatology. Curr Psychiatry Rep. 2014;16(6):1-9. https://doi.org/10.1007/s11920-014-0449-9 - PMid:24740235
World Health Organization (WHO). International Classification of Diseases. 11th revision. The global standard for diagnostic health information. ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS) 2018 version. https://icd.who.int/en
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition (DSM-5). Arlington: American Psychiatric Publishing; 2013.
https://doi.org/10.1176/appi.books.9780890425596
Walther MR, Flessner CA, Conelea CA, Woods DW. The milwaukee inventory for the dimensions of adult s kin picking (MIDAS): initial development and psychometric properties. J Behav Ther Exp Psychiatry. 2009;40(1):127-35. https://doi.org/10.1016/j.jbtep.2008.07.002 - PMid:18725154
Tucker BTP, Woods DW, Flessner CA, Franklin SA, Franklin ME. The skin picking impact project: phenomenology, interference, and treatment utilization of pathological skin picking in a population-based sample. J Anxiety Disord. 2011;25(1):88-95.
https://doi.org/10.1016/j.janxdis.2010.08.007 - PMid:20810239
Harries MD, Chamberlain SR, Redden SA, Odlaug BL, Blum, AW, Grant JE. A structural MRI study of excoriation (skin-picking) disorder and its relationship to clinical severity. Psychiatry Res Neuroimaging. 2017;269:26-30. https://doi.org/10.1016/j.pscychresns.2017.09.006
PMid:28918268 - PMCid:PMC5604737
Selles RR, McGuire JF, Small BJ, Storch EA. A systematic review and meta-analysis of psychiatric treatments for excoriation(skin-picking) disorder. Gen Hosp Psychiatry. 2016;41:29-37. https://doi.org/10.1016/j.genhosppsych.2016.04.001 - PMid:27143352
Keuthen NJ, Deckersbach T, Wilhelm S, Engelhard I, Forker A, O'Sullivan RL, Jenike MA, Baer L. The skin picking impact scale (SPIS): scale development and psychometric analyses. Psychosomatics. 2001;42(5):397-403. https://doi.org/10.1176/appi.psy.42.5.397 - PMid:11739906
Grant JE, Odlaug BL, Chamberlain SR, Kim SW. A bouble-blind, placebo-controlled trial of lamotrigine for pathologic skin picking: treatment efficacy and neurocognitive predictors of response. J Clin Psychopharmacol. 2010;30(4):396-403.
https://doi.org/10.1097/JCP.0b013e3181e617a1 - PMid:20531220 - PMCid:PMC3172612
Anzengruber F, Ruhwinkel K, Ghosh A, Klaghofer R, Lang UE, Navarini AA. Wide range of age of onset and low referral rates to psychiatry in a large cohort of 38 acne excoriée at a Swiss tertiary hospital. J Dermatolog Treat. 2017;24:1471-753. https://doi.org/10.1080/09546634.2017.1364693
Schumer MC, Bartley CA, Bloch MH. Systematic review of pharmacological and behavioral treatments for skin picking disorder. J Clin Psychopharmacol. 2016;36(2):147-52. https://doi.org/10.1097/JCP.0000000000000462 - PMid:26872117 - PMCid:PMC4930073
Azrin NH, Nunn RG. Habit-reversal: a method of eliminating nervous habits and tics. Behav Res Ther. 1973;11(4):619-28. https://doi.org/10.1016/0005-7967(73)90119-8
Rothbaum BO. The behavioral treatment of trichotillomania. Behav Cogn Psychother. 1992;20(1):85-90.
https://doi.org/10.1017/S0141347300016372
Lochner CR, A. Stein, D.J. Excoriation (skin picking) disorder: a systematic review of treatment options. Neuropsychiatr Dis Treat. 2017;13:1867-72. https://doi.org/10.2147/NDT.S121138 PMid:28761349 - PMCid:PMC5522672
Hayes SL, Storch EA, Berlanga L. Skin picking behaviors: an examination of the prevalence and severity in a community sample. J Anxiety Disord. 2009;23:314-9.
https://doi.org/10.1016/j.janxdis.2009.01.008 - PMid:19223150
Schuck K, Keijsers GP, Rinck M. The effects of brief cognitive-behaviour therapy for pathological skin picking: a randomized comparison to wait-list control. Behav Res Ther. 2011;49:11-7. https://doi.org/10.1016/j.brat.2010.09.005
Mohammad J, Ferdnand CO. Use of topiramate in skin-picking disorder: a pilot study. Prim Care Companion CNS Disord. 2017;19(1). https://doi.org/10.4088/PCC.16m01961
Xavier ACM, Souza CMB, Flores LHF, Bermudez MB, Silva RMF, Oliveira AC, Dreher CB. Skin picking treatment with the Rothbaum cognitive behavioral therapy protocol: a randomized clinical trial. Braz J Psychiatry. 2020;42(5): 510-518. https://doi.org/10.1590/1516-4446-2019-0636
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