There are no clear-cut rules governing compulsive skin picking. The picking can take place anywhere on one's body. The picking can target real blemishes or it can target imaginary flaws. It can involve picking, pulling, poking, prodding, squeezing, and tearing. Or it can involve scratching. When CSP takes the form of scratching, it is frequently diagnosed as neurotic excoriation, or an unfounded, undeniable urge to scratch. The urge to scratch is a manifestation of distorted perception, a symptom of neurosis, and the scratching can be so vigorous as to cause permanent tissue damage.
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Neurotic excoriation is instantly recognizable as excessive scratching, different from the look of the tissue damage done by picking, prodding, and squeezing. The lesions caused by the scratching usually look like clusters of long, clean abrasions, all similar in size, that look just like someone has scratched excessively. The permanent scar tissue that can develop retains the clean, linear look of the wound but the scar tissue itself may be lighter or darker than the surrounding skin, depending upon skin type.
Patients with neurotic excoriation run the risk of the disorder escalating into a more overwhelming form of compulsive skin picking. Some patients report the urge to scratch began the cycle but the scabbing from the healing wound compelled them to pick at it. When the urge to pick becomes uncontrollable, the patient faces the challenge of overcoming neurotic excoriation compounded by other forms of dermatillomania.
When neurotic excoriation is suspected, a legitimate reason to scratch so aggressively may never be revealed during a physical examination. The patient, however, may express the feeling or sensation of something crawling or growing on the skin or even under it. They may claim there is something imbedded or sticking out from the skin. People with neurotic excoriation usually target easily accessible areas of the skin, such as that of the face, neck, shoulders, and extremities. About 2% of all dermatology patients become diagnosed with neurotic excoriation, with the onset of the disorder happening most often in females between the ages of 30 and 45.
For more information about Neurotic Excoriation causes and treatment, get the Complete Guide to Picking Disorders today.