‘Look Beyond Skin’: Psychogenic Excoriation - A Series of Five Cases
An 11-year-old school boy presented with pigmentation over face and extremities of 4 month duration. He had intense urge to scratch his face following stress at school and relief after the act. It was followed by excoriations which resolved with hyperpigmentation.\nThere were multiple hyper pigmented macules over face, upper chest, forearms and dorsa of hands []. On psychological evaluation, he was found to have anxiety traits. 3 sessions of behavioral management with reinforcement was done. Distraction techniques and habit reversal were introduced. These were explained to parents and he was asked to practice it at home. Psychiatrist opinion was sought and the patient was started on oral escitalopram 10 mg/day. Skin hyperpigmentation was treated with topical demelanizing cream.\nIn the initial few days of therapy, patient continued to report of recurrent urge to scratch but they decreased with psychological therapies and psychotropic medication. Skin picking scale score reduced from 20/24 to 0/24 at 6-month follow-up and skin hyper pigmentation was also found to have improved considerably.