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Repetitive self-excoriation — Clinical Guidelines

Overview

Repetitive self-excoriation, often categorized under body-focused repetitive behaviors (BFRBs), involves compulsive skin picking that can lead to significant physical and psychological distress, particularly affecting dermatological outcomes and mental health 3 4 5.

Diagnosis

Clinical presentation characterized by repetitive skin picking leading to lesions and scarring 4 5.

Often underrecognized; dermatologists frequently encounter the physical consequences 4.

Psychological assessment may reveal underlying anxiety, depression, or obsessive-compulsive traits 5.

Management

First-line treatments: Cognitive-behavioral therapy (CBT) aimed at modifying behavior and addressing psychological triggers 4.

Adjunctive treatments: Habit reversal training (HRT) to increase awareness and develop competing responses 4.

Pharmacotherapy: Limited evidence; selective serotonin reuptake inhibitors (SSRIs) may be considered for comorbid psychiatric conditions 3.

Special Populations

Pediatrics: Early intervention with behavioral therapies is crucial; recognition and support from dermatologists are vital 5.

Comorbidities: Patients with acne-induced postinflammatory hyperpigmentation may require integrated dermatological and psychological care 5.

Key Recommendations

Implement cognitive-behavioral therapy (CBT) for addressing psychological triggers and modifying behavior patterns (Evidence: Moderate 4).

Utilize habit reversal training (HRT) as an adjunctive therapy to increase awareness and develop alternative responses (Evidence: Moderate 4).

Consider selective serotonin reuptake inhibitors (SSRIs) for patients with comorbid anxiety or depression, though evidence is limited (Evidence: Weak 3).

Enhance ergonomic practices in work environments to prevent exacerbation of repetitive strain injuries, particularly relevant for professionals like radiologists (Evidence: Moderate 7 12).

Promote early recognition and intervention in pediatric populations to mitigate long-term psychological and physical impacts (Evidence: Expert opinion 5).

References

1 de Waal A, Killian A, Gagela A, Baartzes J, de Klerk S. Therapeutic Approaches for the Prevention of Upper Limb Repetitive Strain Injuries in Work-Related Computer Use: A Scoping Review. Journal of occupational rehabilitation 2025. link 2 Soussahn S, Buckwalter K, Sayegh R, Soliman S, Weadock W, Gaetke-Udager K. Ergonomic considerations for the modern radiology practice: An update. Current problems in diagnostic radiology 2024. link 3 Whiting C, Azim SA, Friedman A. Updates in the Treatment of Body-Focused Repetitive Disorders. Journal of drugs in dermatology : JDD 2023. link 4 Madan SK, Davidson J, Gong H. Addressing body-focused repetitive behaviors in the dermatology practice. Clinics in dermatology 2023. link 5 Ekore RI, Ekore JO. Excoriation (skin-picking) disorder among adolescents and young adults with acne-induced postinflammatory hyperpigmentation and scars. International journal of dermatology 2021. link 6 Mulla DM, McDonald AC, Keir PJ. Joint moment trade-offs across the upper extremity and trunk during repetitive work. Applied ergonomics 2020. link 7 Sze G, Bluth EI, Bender CE, Parikh JR. Work-Related Injuries of Radiologists and Possible Ergonomic Solutions: Recommendations From the ACR Commission on Human Resources. Journal of the American College of Radiology : JACR 2017. link 8 Peres SC, Kortum PT, Akladios M, Muddimer A. Developing and validating a self-report assessment tool for software biomechanics. Work (Reading, Mass.) 2015. link 9 Thompson AC, Kremer Prill MJ, Biswal S, Rebner M, Rebner RE, Thomas WR et al.. Factors associated with repetitive strain, and strategies to reduce injury among breast-imaging radiologists. Journal of the American College of Radiology : JACR 2014. link 10 Hoozemans MJ, Speklé EM, van Dieën JH. Concurrent validity of questions on arm, shoulder and neck symptoms of the RSI QuickScan. International archives of occupational and environmental health 2013. link 11 Breslin FC, Ibrahim S, Smith P, Mustard C, Amick B, Shankardass K. The demographic and contextual correlates of work-related repetitive strain injuries among Canadian men and women. American journal of industrial medicine 2013. link 12 Janga D, Akinfenwa O. Work-related repetitive strain injuries amongst practitioners of obstetric and gynaecological ultrasound worldwide. Archives of gynecology and obstetrics 2012. link 13 Ruddy F, Eduardo M, Edoardo S. Three years of the OCRA methodology in Brazil: critical analysis and results. Work (Reading, Mass.) 2012. link 14 Huang TS, Cheng WC, Lin JJ. Relationship between trapezius muscle activity and typing speed: taping effect. Ergonomics 2012. link 15 Green S. Concomitant trichotillomania cessation and thumb-sucking elimination: of course, they're related...aren't they?. The International journal of orofacial myology : official publication of the International Association of Orofacial Myology 2009. link 16 Mandel S. Neurologic syndromes from repetitive trauma at work. Postgraduate medicine 1987. link

Repetitive self-excoriation