Neurotic excoriations: A review and some new perspectives

Abstract

Neurotic excoriation is a commonly encountered dermatologic syndrome, which is usually associated with psychiatric pathology, most commonly obsessive-compulsive traits and depression. This disorder typically runs a chronic course. In addition to symptomatic dermatologic treatments for the self-inflicted excoriations and secondary pruritus, the treatment for this disorder is primarily psychiatric. In spite of this, neurotic excoriation has received little attention in the psychiatric literature, probably reflecting a lack of adequate collaboration between the dermatologist and the psychiatrist. This article critically reviews the literature on this disorder, and presents the salient features of five consecutive cases seen at the psychiatry-dermatology liaison clinic at our hospital. Possible etiology and treatment strategies in a previously unreported subgroup of patients with seemingly intractable symptoms are discussed. Further, the review highlights the fact that knowledge of this symptom complex is important for all psychiatrists, since it is frequently a "cutaneous sign" of psychopathology.