‘Look Beyond Skin’: Psychogenic Excoriation - A Series of Five Cases
A 20-year-old girl presented with scratching and picking of lips, face and arms of 3 years duration which increased with stress. She did not realize that she was picking but became aware only when it started bleeding or when others pointed it out. She also had sad mood, crying spells and increased irritability since 2 months.\nOn examination, numerous excoriated lesions and hyperpigmented macules were present over face, lips and forearms []. On evaluation by clinical psychologists the patient was found to have depressive symptoms. Excoriations were treated with topical antibiotics. Supportive therapy was initiated. Relaxation training with 5 sessions of Jacobson's progressive muscle relaxation was started and was advised to continue. The scratching behavior was managed behaviorally by habit reversal, awareness training and competing response.\nAt six month follow-up, the skin picking scale[] score reduced from 15/24 to 9/24. She noted a transient reduction in irritability and gradually achieved control over her picking behavior over the period. She also solved her interpersonal issues with friends and made new friends.