Neurotic Excoriations -- American Family Physician

www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1981 mented. All lesions are usually of similar size and shape. Patients “dig”at their skin to relieve itching or to extract imaginary objects that they believe are imbedded or extruding from their skin. The lesions are grouped at sites of the body that are easily accessible and usually exposed, such as the extensor surfaces of the extremities, face and upper back (Figure 1). The excoriations present in various stages: dug-out ulcers, ulcers covered with crusts and surrounded by erythema, and areas receding into depressed scars (Figure 2). The number of excoriations can vary from a few to several N eurotic excoriations are skin lesions produced by the patient through repetitive scratching, without an underlying physical pathology. The patient often has a comorbid mental illness (usually anxiety or a mood disorder). Unlike other self-inflicted dermatoses (e.g., dermatitis artefacta and malingering), the patient with neurotic excoriations acknowledges the selfinflicted nature of the lesions. The quantity of lesions varies, ranging from a few to several hundred, and the lesions are located in easily accessible places on the body. Although it has not been reported in the primary care literature, the incidence and prevalence of neurotic excoriations is thought to be common and underreported. There is a 2 percent incidence of neurotic excoriations among dermatology clinic patients and a 9 percent prevalence of neurotic excoriations in patients with pruritus. The condition primarily affects female patients (52 to 92 percent in various studies). Most studies report a mean onset between ages 30 and 45 years.