Skin Picking: Considerações clínicas

Abstract

INTRODUCTION: Skin picking also known as neurotic excoriation, psychogenic excoriation or dermatothylexomania is a common psychiatric disorder in general population, described in the medical literature since 19th century, which is characterized by the repeated act of touching, cutting, pinching or scratching the skin, generating visible and perceptible skin lesions in previously or apparently healthy body regions. It is a syndrome of chronic evolution, with a prevalence between 1,4% to 5,4%, more common in females and beginning mainly in adolescence. With this article, we intend to study the dermatothylexomania clinic in order to familiarize the different health professionals of its importance, and to evaluate possible relationships and similarities with other psychiatric disorders that can be confusing and hinder the diagnosis of skin picking, thus allowing that patients are treated correctly and early. METHODS: A bibliographic search was carried out on the internet, using PubMed scientific research program. Articles between 2008 and 2020 were analyzed, and the most relevant and pertinente to the topic in question were selected. RESULTS: After reviewing the different articles, we found that skin picking patients suffer not only from physical pain, but also from psychological pain. There are several factores that trigger this disorder, and most patients describe states of high tension and nervousness prior to the episodes, which attenuate with act of injuring their own skin. In addition, the age of onset of symptoms has proved to be an important clinical marker. The face is the most affected area, and the method of handling the skin is highly variable. We also found that skin picking and trichotillomania have similarities in relation to demographic data, personality traits and comorbidities and the act of picking the skin, also resembles compulsive rituals verified in obsessive compulsive disorder. CONCLUSION: Despite being a very prevalent pathology and with considerable impact wordwide, it is still under-diagnosed, poorly studied and with low rates of therapeutic adherence. It is a very heterogeneous population which has similarities with other psychiatric disorders and that often camouflages the lesions, therefore requiring a complete physical and psychiatric evaluation, which includes the differential diagnoses, and awareness by health professionals in order to reduce the false diagnoses that currently occur, allowing patients to be treated early and correctly.