A Case Report On Excoriation Disorder and Type 1 Hypersensitivity; A District Health Facility-Based Study

Abstract

Excoriation disorder (ED) or psychogenic excoriation is a "repetitive and compulsive picking of skin which results in tissue damage" characterized by an obsessive-compulsive spectrum mental disorder with a repeated urge or impulse to pick at one's own skin to the
extent of causing psychological or physical damage. Prevalence of this condition is unavailable in developing countries of the world. It is classified as "L98.1 Excoriation (skin-picking) Disorder" in ICD-10 and referred in some literature as "dermatillomania". ED is characterized by, but not invariably, the compulsive urge to pick, squeeze or scratch skin surfaces experienced by patients. Commonly picked parts of the body include the face (most picked), arms, legs, back, gums, neck, shoulders, scalp, abdomen, chest, the knuckles (via mouth leading to temporary disfiguration of distal and proximal joints of the middle and little fingers) and other extremities e.g. the fingernails, cuticles, and toe nails;5 skin picking may be accompanied by anxiety with depression following picking.  It is often triggered by factors that include feeling or examining irregularities on the skin, feeling anxious etc. Complications include infections, tissue damage and sepsis. Rarely, severe cases cause lifethreatening injuries. Risk of self-harm is increased by feelings of intense helplessness, guilt, shame and embarrassment.8 Studies further describe significant associations between ED and suicidal ideation, suicidal attempts and psychiatric hospitalizations.