Recommendations For Treating Excoriation

Also known as dermatillomania, excoriation is a mental health condition closely related to obsessive-compulsive disorder. Patients who have excoriation repeatedly pick their skin, and the condition can cause significant disruption to daily life. Patients pick at healthy skin and also at scabs, lesions, pimples, calluses, and other skin irregularities. Some patients may spend several hours each day picking at their skin, and the condition frequently comes and goes, alternating between symptom-free periods and periods of high intensity. Women are diagnosed with excoriation more often than men, and the disorder affects a little over one percent of the population. Most patients develop this condition near puberty, and it is also common in adults under forty-five years old. The treatment recommendations outlined below are often beneficial in patients with excoriation.

Habit Reversal Training

Habit reversal training is a behavior-based approach to the treatment of excoriation and other repetitive behaviors such as hair pulling. The training regimen was originally developed in the 1970s and operates on the premise that patients who engage in the repetitive behaviors are unaware they are doing so. Practitioners believe the repetitive behaviors occur because patients are experiencing underlying discomfort or urges trapped within their subconscious. The goal of habit reversal training is to make patients aware of their repetitive behaviors and replace these with behaviors that are less disruptive for the patient. Patients monitor themselves for repetitive behavior and keep a behavior diary to record incidents of this behavior. After several weeks of learning to recognize their behavior, patients focus on developing a competing response. The competing response varies according to the patient's situation, and it is ideally held for at least one minute. Therapists try to help patients develop competing responses that make it impossible to engage in the previous unwanted behavior. For example, patients who pick their skin with their right hand may be encouraged to sit on that hand or make a fist with it to prevent skin picking. In patients with milder forms of excoriation, habit reversal may be the only line of treatment necessary.

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Control Of Stimuli

Controlling stimuli involves making changes to the patient's environment. These changes reduce the sensory input that leads the patient to engage in skin picking and make it more difficult for them to pick their skin. For example, control of stimuli for a patient who frequently picks their skin while looking in the bathroom mirror would likely involve dimming the bathroom lights or even removing the bathroom mirror. Patients who pick their skin when they are by themselves would be encouraged to spend more time with others to reduce their skin picking. Control of stimuli is often taught as part of psychological therapy, and professionals can help guide patients in the most beneficial stimuli controls for their behavior. They will also provide accountability for patients.

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Medications

Medications may be necessary for patients with moderate to severe forms of excoriation. The most commonly prescribed medications for this condition are selective serotonin reuptake inhibitors, which are a type of antidepressant, and can help patients who pick their skin by reducing the anxiety and depression that can trigger episodes. Many selective serotonin reuptake inhibitors are available in both tablet and liquid formulations. Patients taking this kind of medication should be closely monitored by their healthcare team for changes in mood, increased aggression, and memory changes. Possible side effects include insomnia, diarrhea, constipation, dry mouth, agitation, restlessness, feeling nervous, nausea, headache, and blurred vision.

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Cognitive Therapy

Cognitive therapy is generally the core treatment for excoriation. It includes many possible approaches, and habit reversal is considered the most effective in current literature. Psychologists often use a form of therapy known as acceptance and commitment therapy to supplement habit reversal. This therapeutic technique encourages patients to recognize their urges to engage in skin picking and let them pass without feeling the need to respond. If necessary, clinicians frequently employ dialectic behavior therapy during the treatment process. This approach teaches patients how to better regulate their emotions. Patients also learn strategies to help them tolerate the discomfort, urges, and unpleasant feelings that may emerge. Cognitive therapy can take several months of work before patients begin to feel better, so it is important not to give up on the treatment in the early stages. Psychologists encourage patients to have social support and to celebrate small victories as their treatment progresses. Many patients need to have therapy sessions at least once a week.

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Yoga And Mindfulness

Yoga and mindfulness are useful complementary therapies that can be used in conjunction with psychotherapy and medication. There are many different forms of yoga available. Restorative yoga emphasizes relaxation, breathing techniques, meditation, and gentle movement. Bikram yoga and hot yoga are more active forms that focus on fitness and involve continuous flow from one movement into the next. Hot yoga is performed in a heated room, which can help increase flexibility. Mindfulness can be practiced daily, and teaches individuals to be fully present and live in the moment. For example, clients are taught to savor each bite of food, enjoy the sensation of the sun on their skin, and notice how their body feels when lying, seated, and moving through space. Both yoga and mindfulness can help individuals who pick their skin to distract themselves and reduce their urges to pick. These approaches can make competing responses and stimuli control more successful.