eMedicine Specialties > Dermatology > Psychocutaneous Diseases

Neurotic Excoriations: Follow-up

Author: Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Contributor Information and Disclosures

Updated: Jan 7, 2010

Follow-up

Further Outpatient Care

  • Patients with neurotic excoriations can be seen by psychiatrists and benefit from follow-up care to encourage the maintenance of treatment.

Inpatient & Outpatient Medications

  • As outpatients, patients with neurotic excoriations can be treated with low-dose psychotropic medications and cortisone creams.

Complications

  • If neurotic excoriations are not treated, they can result in scarring.

Prognosis

  • Neurotic excoriations can be controlled if the underlying psychological illness is controlled. Patients need intervention but sometimes have difficulty in changing the habit of picking. Without medical and psychiatric treatment, this tends to be a chronic condition.

Patient Education

  • Patients with neurotic excoriations need to understand that they can be helped and that the urge to itch can be a representation of other underlying conditions.

Miscellaneous

Medicolegal Pitfalls

  • Because psychotropic medications can treat neurotic excoriations, doctors must be ready to prescribe them for neurotic excoriations or to refer patients to doctors who will. Fried notes that lawsuits have occurred against doctors for not treating patients who itch themselves and are left with scars.14
 


More on Neurotic Excoriations

Overview: Neurotic Excoriations
Differential Diagnoses & Workup: Neurotic Excoriations
Treatment & Medication: Neurotic Excoriations
Follow-up: Neurotic Excoriations
Multimedia: Neurotic Excoriations
References
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References

  1. Shah KN, Fried RG. Factitial dermatoses in children. Curr Opin Pediatr. Aug 2006;18(4):403-9. [Medline].

  2. Andreoli E, Finore ED, Provini A, Paradisi M. [Self-inflicted dermatitis: a case in pediatric age]. Minerva Pediatr. Jun 2008;60(3):355-9. [Medline].

  3. Cyr PR, Dreher GK. Neurotic excoriations. Am Fam Physician. Dec 15 2001;64(12):1981-4. [Medline].

  4. Setyadi HG, Cohen PR, Schulze KE, et al. Trigeminal trophic syndrome. South Med J. Jan 2007;100(1):43-8. [Medline].

  5. Shenefelt PD. Using hypnosis to facilitate resolution of psychogenic excoriations in acne excoriée. Am J Clin Hypn. Jan 2004;46(3):239-45. [Medline].

  6. Koblenzer CS. Neurotic excoriations and dermatitis artefacta. Dermatol Clin. Jul 1996;14(3):447-55. [Medline].

  7. Krishnan A, Koo J. Psyche, opioids, and itch: therapeutic consequences. Dermatol Ther. Jul-Aug 2005;18(4):314-22. [Medline].

  8. Fellner MJ, Majeed MH. Tales of bugs, delusions of parasitosis, and what to do. Clin Dermatol. Jan-Feb 2009;27(1):135-8. [Medline].

  9. Dereli T, Karaca N, Inanir I, Oztürk G. Gabapentin for the treatment of recalcitrant chronic prurigo nodularis. Eur J Dermatol. Jan-Feb 2008;18(1):85-6. [Medline].

  10. Fried RG. Nonpharmacologic treatments in psychodermatology. Dermatol Clin. Jan 2002;20(1):177-85. [Medline].

  11. Gupta MA, Gupta AK. Olanzapine may be an effective adjunctive therapy in the management of acne excoriée: a case report. J Cutan Med Surg. Jan-Feb 2001;5(1):25-7. [Medline].

  12. Biondi M, Arcangeli T, Petrucci RM. Paroxetine in a case of psychogenic pruritus and neurotic excoriations. Psychother Psychosom. May-Jun 2000;69(3):165-6. [Medline].

  13. Gupta MA, Gupta AK. Fluoxetine is an effective treatment for neurotic excoriations: case report. Cutis. May 1993;51(5):386-7. [Medline].

  14. Fried R. Psychodermatology. Dialogues in Dermatology. American Academy of Dermatology. Available at http://www.aad.org/Marketplace/Catalog/dialogues.html. Accessed 2003.

  15. Bennassar A, Guilabert A, Alsina M, Pintor L, Mascaro JM Jr. Treatment of delusional parasitosis with aripiprazole. Arch Dermatol. Apr 2009;145(4):500-1. [Medline].

  16. Gupta MA, Lanius RA, Van der Kolk BA. Psychologic trauma, posttraumatic stress disorder, and dermatology. Dermatol Clin. Oct 2005;23(4):649-56. [Medline].

  17. Koblenzer CS. Psychocutaneous disease. Clin Dermatol. 1985;4:1-14.

  18. Shapira NA, Lessig MC, Murphy TK, Driscoll DJ, Goodman WK. Topiramate attenuates self-injurious behaviour in Prader-Willi Syndrome. Int J Neuropsychopharmacol. Jun 2002;5(2):141-5. [Medline].

  19. Usatine RP, Saldana-Arregui MA. Excoriations and ulcers on the arms and legs. J Fam Pract. Sep 2004;53(9):713-6. [Medline].

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Further Reading

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Keywords

neurotic excoriations, neurotic excoriation, NE, picker's nodules, prurigo nodularis, repetitive scratching, unconscious picking at the skin, uncontrollable picking at lesions, dermatitis artefacta

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Contributor Information and Disclosures

Author

Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Optigenex Consulting fee Independent contractor

Medical Editor

Shyam Verma, MBBS, DVD, FAAD, Adjunct Clinical Assistant Professor, Department of Dermatology, University of Virginia, State University of New York at Stonybrook, Penn State University
Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Rosalie Elenitsas, MD, Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis  investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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