The Dermatilomania Is a psychopathological alteration that is characterized by an extreme need to touch, scratch, rub, scrub or rub the skin.
People with this disorder are unable to resist conducting such behaviors, so they scratch the skin impulsively to mitigate the anxiety of not doing so.
Obviously, suffering this psychological alteration can greatly damage the integrity of the person as well as provide a high discomfort and significantly affect his day to day.
In this article we will review what is known today about dermatilomania, what features this disease has and how it can be treated.
What is the relationship between the skin and mental disorders?
Dermatilomania is a psychopathological disorder that was first described by Willson under the name of skin picking.
In essence, this psychological alteration is characterized by the need or urgency to touch, scratch, rub, rub, squeeze, bite or dig the skin with nails and / or accessory tools such as tweezers or needles.
However, dermatilomania remains today a psychopathological entity little known and with many questions to answer.
During the last few years, much debate has been opened as to whether this disturbance would be part of the obsessive-compulsive spectrum or impulse control disorder.
That is, if the dermatilomania consists of an alteration in which the person performs a compulsive action (scratching) to mitigate the anxiety that causes a certain thought, or an alteration in which the person is unable to control their immediate needs to rub your skin.
At present, there seems to be a greater consensus for the second option, understanding dermatilomania as a disorder in which, in the presence of pruritus or other skin sensations such as burning or tingling, the person feels an extreme need to scratch, for Which ends up performing the action.
However, the relationship between the skin and the nervous system seems to be very complex, so there are multiple associations between psychological alterations and cutaneous alterations.
In fact, the brain and skin have many associative mechanisms, so that through their injuries, the skin can account for the emotional and mental state of the person.
More specifically, a review by Gupta revealed that between 25 and 33% of dermatological patients had some associated psychiatric pathology.
Thus, a person suffering from alterations in the skin and in the mental state, as is the case of individuals suffering from dermatilomania, should be evaluated as a whole and guide the explanation to the alterations suffered in two slopes.
1. As a dermatological disorder with psychiatric aspects.
2. As a psychiatric disorder with dermatological expression.
These data show how the relationship between skin and mental state is bidirectional, ie, skin alterations can lead to psychological problems, and psychiatric disorders can cause skin alterations.
Obviously, when we talk about dermatilomania, we are referring to the second slope, that is, a psychopathological alteration (dermatilomania) causes effects on the skin due to compulsive scratching.
However, dermatilomania is not the only mental alteration that can cause skin alterations, since other diseases such as depression , he Obsessive compulsive disorder , he Body dysmorphic disorder or the Posttraumatic stress disorder It can also cause skin problems.
Likewise, repetitive acts similar to those observed in dermatilomania, such as nail biting, do not imply the presence of a psychological alteration or the presence of a skin problem.
But what if the act of nail biting causes wounds, bleeding, or infections, or if the act of pinching"blackheads"causes definite moles, blemishes and stretch marks?
In these cases, an action that in principle normal, would become pathological, since the person perform repetitive acts on his skin despite being causing damage and illness.
Thus, with this brief review of the relationship between mental status and cutaneous status, we already see that the definition of a psychopathological entity such as dermatilomania is more complex than could be at first sight.
Characteristics of dermatilomania
Dermatilomania, is also known today through other names such as compulsive skin scraping, neurotic excoriation, psychogenic excoriation or excoriated acne.
With these 4 alternative names to the dermatilomania, we can already see more clearly what is the main expression of the mental alteration.
In fact, the main feature is based on the feelings of need and urgency that the person experiences at certain times of scratching, rubbing or rubbing their skin.
Typically, these feelings of need to scratch appear to respond to the appearance of minor irregularities or defects in the skin, as well as the presence of acne or other formations on the skin.
As we have said before, scratching is done in a compulsive way, that is, the person can not avoid scratching the determined area, and is done through the nails or some utensil.
Obviously, this scratching, either with the nails or with tweezers or needles, usually causes tissue damages of different severity, as well as skin infections, definitive and deforming scars, and significant aesthetic / emotional damage.
Initially, the clinical picture that defines dermatilomania appears in response to pruritus or other skin sensations such as burning, tingling, heat, dryness or pain.
When these feelings appear, the person experiences immense needs of scratching that zone of skin, reason why initiates behaviors of compulsive scratching.
It is necessary to point out that if we understand the alteration as a disorder of impulse control as an obsessive compulsive disorder, the person can not resist performing the scratching actions because if he does not he is not able to get rid of the tension that he Not suppose to do so.
Thus, the person begins to scratch the skin in a totally impulsive way, without being able to stop to reflect if he should do it or not, and evidently, causing marks and wounds in the cutaneous zone.
Subsequently, the scratching pulses do not appear pruritus , acne Or other natural elements of the skin, but by the permanent observation of the skin itself.
In this way, the person with dermatilomania begins to analyze in an obsessive way the state of the skin, fact that makes controlling or resisting their desire to scratch becomes a task almost impossible.
During the observation the nervousness, tension and restlessness is increasing, and can only diminish if the action is carried out.
When the person finally performs the action of scratching or rubbing his skin impulsively, he experiences high sensations of gratification, pleasure and relief, which some patients come to describe as a state of trance.
However, as the action of scratching continues, the feelings of gratification diminish while the previous tension disappears.
Thus, we could understand the pattern of dermatilomania functioning as extreme tension sensations which are eliminated through the action of rubbing the skin, behavior that provides a lot of gratification at first, but disappears when there is no such tension .
As we see, although we have to save many important distances, this pattern of behavior differs little from that made by a person addicted to a certain substance or behavior.
Thus, the smoker who spends many hours without being able to smoke increases his state of tension, which is released when he manages to light his cigarette, at which time he experiences great pleasure.
However, if this smoker continues to smoke one cigarette after another, when he is smoking the fourth consecutive cigarette, he probably will not experience any kind of tension and the nicotine reward will probably be much lower.
Resuming the dermatilomania, as the action of scratching the skin, the gratification disappears, and instead begin to appear feelings of guilt, regret and pain, which increase progressively as the action of scratching continues .
Finally, the person suffering from dermatilomania feels shame and self-reproach for the wounds and injuries resulting from their compulsive scratching behaviors, a fact that can lead to multiple personal and social problems.
What data is available on dermatilomania?
So far we have seen that dermatilomania deals with a disorder of impulse control in which the person is unable to resist scratching certain areas of his skin due to the previous tension caused by self-observation and detection of certain aspects of the skin.
However, what areas of the body do you usually scratch? What feelings does the person suffering from this disorder have? What behaviors do they normally do?
As has been mentioned, there is still little knowledge about this psychological disorder, however, authors such as Bohne, Keuthen, Bloch and Elliot have provided more interesting data in their studies.
Thus, from a bibliographic review made by Doctor Juan Carlo Martínez, we can draw conclusions such as the following.
The sensations of previous tension that describe the patients with dermatilomania rises to levels of between 79 and 81%.
The areas where the scraping is most frequently done are grains and blackheads (93% of cases), followed by insect bites (64%), scabs (57%), infected areas (34%), And healthy skin (7-18%).
The most commonly performed behaviors for people with dermatilomania are: tightening the skin (59-85%), scratching (55-77%), biting (32%), rubbing (22%), digging or removing %), And click (2.6%).
The most commonly used instruments are nails (73-80%), followed by fingers (51-71%), teeth (35%), pins (5-16%), forceps ( 9-14%) and scissors (5%).
The areas of the body most affected by the compulsive behaviors of dermatilomania are the face, arms, legs, back and thorax.
People with dermatilomania try to cover the wounds caused by cosmetics in 60% of the cases, with clothing in 20% and with bandages in 17%.
How many people have it?
The epidemiology of dermatilomania has not yet been well established, so the existing data are not redundant.
In dermatological consultations the presence of this psychopathological disorder is verified between 2 and 4% of cases.
However, the prevalence of this problem in the general population is unknown, in which it is understood that it would be lower than that found in dermatology consultations.
Likewise, in a study that was conducted to 200 psychology student found as the majority, 91.7% acknowledged having pinched their skin during the last week.
However, these figures were much lower (4.6%) if the skin pinching action was considered as a response to stress or behavior that produced functional impairment, and up to 2.3% if such action was considered to have Some relation to some psychiatric pathology.
How can it be treated?
Today we do not find in the literature a unique and totally effective treatment to intervene this type of psychopathologies.
However, the methods that are most used among mental health services to treat dermatilomania are the following.
1. Pharmacological treatment
Usually used Antidepressant medications Such as selective serotonin or colomipramine inhibitors, as well as opioid antagonists and glutamate agents.
2. Replacement Therapy
This therapy focuses on looking for the underlying cause of the disorder, as well as the effects that can originate.
It helps the patient to develop skills to control the impulse without being damaged and to reduce the scratching behaviors.
3. Cognitive Behavioral Therapy
This therapy Has been very successful in the treatment of obsessive-compulsive disorder, so similar effects are expected in the
Intervention of dermatilomania.
With this treatment, behavioral techniques are developed that prevent the appearance of impulsive acts, and at the same time the obsessive thoughts of scratching are worked out so that they are experienced with lower levels of tension and anxiety .
References
- Bloch M, Elliot M, Thompson H, Koran L. Fluoxetine in Pathologic Skin Picking. Psychosomatics 2001; 42: 314-319
- Bohne A, Wilhelm S, Keuthen N, Baer L, Jenike M. Skin Picking in German Student. Behav Modif 2002; 26: 320?? 339.
- Gupta MA, Gupta AK.The use of antidepressant drugs in dermatology. JEADV 2001; 15: 512?? 518.
- Keuthen N, Deckersbach T, Wilhelm S, Hale E, Fraim C, Baer L et al. Repetitive Skin?? Picking in a Student Population and Comparison with a Sample of Self?? Injurious Skin?? Pickers. Psychosomatics 2000; 41: 210-215
- Wilhelm S, Keuthen NJ, Deckersbach T, et al. (1999) Self-injurious skin picking: clinical characteristics and comorbidity. J Clin Psychiatry 60: 454?? 459.