A 54-year-old woman presents for an initial consultation. She has multiple chronic disorders, including type 2 diabetes mellitus and hypertension, for which she takes various medications—none of which are new.
Skin lesions are noted on her arms and legs. When questioned about them, she says that she has had them for “a long time.” These lesions are somewhat itchy and are aggravated by the patient’s “rubbing” them. She denies any fever, sore throat, vaginal discharge, or previous dermatologic disorders.
Multiple lesions are identified all over her body in no specific pattern; however, they are bilateral and symmetric. The lesions are in different stages of healing, but most are scarred over. After further questioning, the patient says that she has impulses that compel her to “rub” at her skin. She seems embarrassed by the lesions but does not think that they require medical treatment.
WHAT’S YOUR DIAGNOSIS?
1. Ehsani AH, Toosi S, Mirshams Shahshahani M, et al. Psycho-cutaneous disorders: an epidemiologic study. J Eur Acad Dermatol Venereol. 2009;23:945-947.
FOR MORE INFORMATION:
• Jafferany M. Psychodermatology: a guide to understanding common psychocutaneous disorders. J Clin Psychiatry. 2007;9:203-213.
• Lane KL, Thompson A, Reske CL, et al. Reducing skin picking via competing activities. J Appl Behav Annals. 2006;39:459-462.
• Neziroglu F, Rabinowitz D, Breytman A, Jacofsky M. Skin picking phenomenology and severity comparison. J Clin Psychiatry. 2008;10:306-312.