Neurotic / Psychogenic excoriation

 

Neurotic (Psychogenic) excoriation is a medical term used by physicians to refer to repetitive scratching with no known physical pathology. The behavior manifests on the skin as “clean, linear erosions, scabs, and scars…similar in size and shape…grouped on easily accessible body sites.” The most common areas affected by neurotic excoriation include the legs, arms, shoulders, upper back, neck, and face. 

 

 

 

 

 

 

 

 

 

 

Image from American Family Physician

The terms “neurotic” or “psychogenic’ mean that the condition is psychologically motivated rather than physical. However, a differential diagnosis of neurotic excoriations will include ruling out physical causes. Physicians note that some physical conditions such as dry skin, allergies, delirium, hepatic disease, substance use, medication side effects, and thyroid issues may cause neurotic excoriation, but more often the behavior occurs with depression, anxiety, or obsessive-compulsive disorder. There are other cases where neurotic excoriations start with a physical condition but continue long after treatment of the physical causes. 

Dermatological treatments may include topical antibiotics to prevent infection of the scratch wounds, topical steroids to facilitate healing and antihistamines to reduce sensations related to itching. When physicians encounter a patient displaying symptoms of neurotic excoriations, the best practice is to refer the patient to counseling to address the psychological origins of the behavior.

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