Self-induced skin conditions: differential diagnosis and management

Journal article

There exists a wide spectrum of self-induced skin disease that may present to primary care clinicians. At one end are commonly recognised entities, such as lichen simplex chronicus, nodular prurigo, and chronic atopic eczema perpetuated by habitual scratching. At the other end are a range of complex, multifactorial psychodermatological conditions that are challenging to diagnose and manage. This article focuses on skin-picking disorder (SPD), trichotillomania, and dermatitis artefacta (DA), to assist primary care clinicians in managing these conditions effectively. SPD is characterised by repeated picking of the skin, resulting in recalcitrant skin lesions. To satisfy the criteria for a diagnosis of SPD, there must have been persistent attempts by the patient to reduce or discontinue picking, with clinically significant distress or impairment of functioning.1 Females tend to be affected more often, with onset typically in adolescence. Patients may spend several hours at a time picking or gouging at the skin, often in a ritualised fashion, sometimes using various implements. Picking episodes are commonly triggered by increased stress, and comorbid mental health disorders are often associated. All patients with SPD will acknowledge their tendency to pick, to a greater or lesser extent, if questioned sensitively.2 Self-induced skin lesions in SPD are usually obvious on examination. Discrete, monomorphic, eroded, or ulcerated papules, nodules, and plaques tend to be distributed symmetrically over easily accessible sites. Lesions at all stages of the healing process …

Authors: Goulding, JM; Mughal, F

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Royal College of General Practitioners
• Journal: British Journal of General Practice
• Volume: 69
• Issue: 686
• Pages: 464-465
• Publication date: 2019-08-29
• DOI: 10.3399/bjgp19x705449
• EISSN: 1478-5242
• ISSN: 0960-1643
• Language: English
• Keywords: Family medicine; Atopic dermatitis; Psychiatry; Pathology; Medicine; Disease; Dermatology; Distress; Clinical psychology; Primary care; Differential diagnosis