Neurotic Excoriations Secondary to Cutaneous Dysesthesia

Abstract

Ms. Ellington is 34 year-old Caucasian woman presenting with a 1-year history of excoriations on easily reachable areas of the face, neck, dorsal hands, lateral arms, and upper chest. She had been referred to the psychodermatology clinic with an initial diagnosis of “psychosis.” There were no primary skin lesions as noted on the previous physical exam in her records. During the interview, she clearly appeared both embarrassed and apologetic about picking at her skin. She showed no elaborate ideation regarding the reason for her behavior. However, after you asked, “can you tell me exactly what makes you pick your skin?” She reports an intense focal pain in her skin as the cause.