Neurotic Excoriations Medication
- Author: Noah S Scheinfeld, MD, JD, FAAD; Chief Editor: Dirk M Elston, MD more...
Medication Summary
Neurotic excoriations are treated with a variety of psychotropic medications. The doses can be lower than those used in treating depression, and the medications can act more quickly.
Using hypnosis to facilitate resolution of psychogenic excoriations in acne excoriée has been reported.
Olanzapine may be an effective adjunctive therapy in the management of acne excoriée.[15] Paroxetine was reportedly effective in a case of psychogenic pruritus and neurotic excoriations.[16]
Antipsychotic agents
Class Summary
Decrease the urge to scratch and relieve anxiety.
Doxepin (Sinequan)
Inhibits histamine and acetylcholine activity and has proven useful in the treatment of various forms of depression associated with chronic and neuropathic pain.
Antianxiety agents
Class Summary
Used to reduce the level of anxiety in patients who experience pruritus.
Buspirone (BuSpar)
A 5-HT1 agonist with serotonergic neurotransmission and some dopaminergic effects in CNS. Has anxiolytic effect but may take up to 2-3 wk for full efficacy.
Antidepressant agents
Class Summary
May be used to improve mood and to restore normal sleep patterns in patients who experience pruritus.[17]
Fluoxetine (Prozac)
Selectively inhibits presynaptic serotonin reuptake with minimal or no effect in the reuptake of norepinephrine or dopamine.
Topical cortisone agents
Class Summary
Have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body's immune response to diverse stimuli.
Triamcinolone topical (Aristocort)
Treats inflammatory dermatosis that is responsive to steroids. Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability.
Antiepileptic agents
Class Summary
Decrease impulsiveness.
Topiramate (Topamax)
Sulfamate-substituted monosaccharide with broad spectrum of antiepileptic activity that may have state-dependent sodium channel blocking action. Potentiates inhibitory activity of GABA. May block glutamate activity.
Not necessary to monitor plasma concentrations to optimize therapy. On occasion, addition of topiramate to phenytoin may require phenytoin dose adjustment to achieve optimal clinical outcome.
Jafferany M, Vander Stoep A, Dumitrescu A, Hornung RL. The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: results of a survey study. Int J Dermatol. Jul 2010;49(7):784-9. [Medline].
Brodin MB. Neurotic excoriations. J Am Acad Dermatol. Aug 2010;2:341-2. [Medline].
Jafferany M, Vander Stoep A, Dumitrescu A, Hornung RL. The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: results of a survey study. Int J Dermatol. Jul 2010;7:784-9. [Medline].
Shah KN, Fried RG. Factitial dermatoses in children. Curr Opin Pediatr. Aug 2006;18(4):403-9. [Medline].
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].
Cyr PR, Dreher GK. Neurotic excoriations. Am Fam Physician. Dec 15 2001;64(12):1981-4. [Medline].
Setyadi HG, Cohen PR, Schulze KE, et al. Trigeminal trophic syndrome. South Med J. Jan 2007;100(1):43-8. [Medline].
Shenefelt PD. Using hypnosis to facilitate resolution of psychogenic excoriations in acne excoriée. Am J Clin Hypn. Jan 2004;46(3):239-45. [Medline].
Koblenzer CS. Neurotic excoriations and dermatitis artefacta. Dermatol Clin. Jul 1996;14(3):447-55. [Medline].
Krishnan A, Koo J. Psyche, opioids, and itch: therapeutic consequences. Dermatol Ther. Jul-Aug 2005;18(4):314-22. [Medline].
Fellner MJ, Majeed MH. Tales of bugs, delusions of parasitosis, and what to do. Clin Dermatol. Jan-Feb 2009;27(1):135-8. [Medline].
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].
Paley K, Prevost N, English JC 3rd. Unna sleeve for neurotic excoriations. Cutis. Mar 2010;85(3):149-52. [Medline].
Fried RG. Nonpharmacologic treatments in psychodermatology. Dermatol Clin. Jan 2002;20(1):177-85. [Medline].
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].
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].
Gupta MA, Gupta AK. Fluoxetine is an effective treatment for neurotic excoriations: case report. Cutis. May 1993;51(5):386-7. [Medline].
Fried R. Psychodermatology. Dialogues in Dermatology. American Academy of Dermatology. Available at http://www.aad.org/Marketplace/Catalog/dialogues.html. Accessed 2003.
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