Skin Picking Disorders and Dermatitis Artefacta

Dermatologists and patients have long known that skin diseases affect the physical and emotional well-being of a person’s existence. Conversely, the psychological state of a person can also affect his/her skin. In this chapter, we set out the nature and basis of some of the dermatological conditions linked to obsessive compulsive disorders [SPD and Acne excoriee] and also take a look at Dermatitis Artefacta, a poorly understood factitious disorder. We present the process of evaluation and care of this vulnerable group of patients, whilst also highlighting the importance of a holistic approach in a multidisciplinary setting.

The skin is well placed to be the focus of tension reducing and emotion regulating behaviours [1]. High levels of anxiety, in dissociative and obsessive compulsive states is perhaps one of the most significant influences in conditions such as Skin picking disorders [SPD] and Dermatitis Artefacta [DA]. Anxiety can also exacerbate primary skin disorders such as Acne with the development of Acne excoriee.

We know that psychological, psychiatric and psychosocial stress affect over 30% of dermatological patients. Assessment of these co-morbidities is therefore imperative in the overall clinical evaluation of the patient. Therefore an integrated multidisciplinary team approach to manage this group of patients leads to better outcomes.

Keywords: Acne excoriee, Artefactual, Compulsive, Dermatitis artefacta, Dermatology, Dissociation, DSM-5, Excoriation, Multidisciplinary team, Neurotic, Obsessive, Picking, Psychiatric, Psychodermatology, Psychosomatic, Skin.