Excoriation

An excoriation is an erosion or destruction of the skin by mechanical means, which appears in the form of a scratch or abrasion of the skin. It is commonly seen in other skin disorders causing itching/pruritus: dry skin, dermatitis, atopic dermatitis, scabies, etc. The condition is characteristic of a symptom of other illnesses like liver failure where pruritus is caused by increases of bilirubin.

The term can be associated with neurotic excoriations. Neurotic excoriations are considered psychiatric in etiology. A patient with neurotic excoriations should try to avoid picking and scratching their skin. Because of this, another diagnosis should be made if the lesions are found on areas where the hands do not make contact. It doesn't exclude the possibility, but makes it less likely. The disorder is typically found among females more than males. Damage is common on the face, neck, back, and extremities, and damage to the skin is generally caused by rubbing, scratching, and picking. Severe itching from other causes may mimic this disorder.

Diagnosis is often made by exclusion and is identified and isolated by bandaging areas affected unless any improvement to the affected area or significant change in behavior is witnessed.

Treatment may include periodic bandaging, psychiatric guidance with life adjustments, lotions with or without menthol and phenol (hopefully to take the place of scratching). Antidepressants may work in patients with neurotic excoriations. Other medications like bedtime antihistamines, antipruritic, sometimes pimozide, or topical corticosteroids are used if there is another reason for the scratching. These are reserved for other conditions and further work up should be pursued.

In some cases endorphine blocking drugs have been used to stop the neurotic tendencies completely. [The Dog Who Loved Too Much, Nicholas Dodman (p.231)]