Originally published in Cosmetic Dermatology
Barbara, a 34-year-old schoolteacher, noticed that a small blemish on her chin was not healing. As a matter of fact, it had been growing larger and more tender in the last few weeks and sometimes it even bled. Although she tried to keep the area clean and dry, the problem persisted and began to embarrass her. When she finally sought the help of dermatologist, Dr. John Werber, he suspected that Barbara may have been picking, touching, and rubbing the area herself and causing the lesion to become infected. Barbara admitted that she was self-conscious about the blemish and did occasionally try to cover it with her hand when she was talking to people.
“Barbara had some of the classic symptoms of a ‘neurotic excoriation’ – which means that a person is either absent-mindedly or habitually picking small inconsequential lesions on their skin, such as a pimple, and making it much worse,” said Dr. Werber, head of dermatology at the Spellman Center of St. Clare’s Hospital in New York. “Often these marks are warning signs that the patient is under severe stress or anxiety or is suffering from depression.”
According to Dr. Werber some of the signs of neurotic excoriation are well-demarcated wounds on the skin that are within easy reach of the dominant hand. The shape of the wound can vary, but it is often angulated or geometric. Many times people suffering from neurotic excoriations will claim to have no information about how the sore developed.
Because of the well-known psychological component of this condition, family members and friends need to help patients understand their problem and seek appropriate care. Treating physical symptoms is relatively simple. Understanding what is causing a person to engage in their harmful behavior is more challenging. Medications, counseling and a network of support comprise an effective multidiscipline approach toward emotional and cutaneous healing.
A Matter of Degree
Neurotic excoriations fall under the umbrella of conditions known generally as a “factitial syndrome.” This term covers a broad range of self-inflicted injuries to the skin, ranging from unconscious to deliberate actions. In most cases, the skin is damaged when a person picks or rubs it repeatedly. Some people like Barbara do not seem to be aware of the harm they are doing to themselves. Others know they are causing injury, but have difficulty controlling the urge to rub, pick or scratch. In more extreme situation, “factitial” injuries occur when individuals apply caustic chemicals or use sharp instruments on the skin.
Compulsively picking acne results in a condition known as acne excorieé. Scarring and darkened areas in the place of blemishes are its telltale signs. Acne excorieé is relatively common and is more of a bad habit than a serious condition. Most people recognize that they sometimes engage in this behavior and they also know that it can damage the skin. For these individuals, breaking the habit can be accomplished by simply making a conscious effort to stop. Some “factitial syndromes” are more extreme and require medical intervention. Knowing when a doctor’s help is needed requires careful observation.
Every one of us has symptoms of neurotic disorder. It’s all a matter of degree. Everyone picks their pimples once in a while. But when we begin to do damage to the skin or when the picking interferes with normal activities, then there may be more serious problems afoot,” said Richard G. Fried, M.D., Ph.D., an expert in stress-related skin disorders with a private practice in Yardley, Pa.
Dr. Fried, a psychologist and dermatologist says that people relieve their anxiety in different ways – from drinking alcohol to biting their nails to exercising or having sex. Scratching at the skin is a form of anxiety reduction.