Skin Picking Disorder — SCE Dermatology MCQ

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ModeratePsychodermatologySkin Picking DisorderSCE Dermatology

A 22-year-old woman presents with neurotic excoriations on her forearms. She reports irresistible urges to pick at her skin and acknowledges causing the lesions herself. She has no delusional beliefs about her skin. What is the most appropriate management approach?

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Correct answer: E — CBT focused on habit reversal and consider SSRI therapy

Option E, CBT focused on habit reversal and consider SSRI therapy, is correct. This patient has excoriation (skin-picking) disorder: repetitive self-inflicted skin damage driven by irresistible urges, with full insight and no delusional belief about infestation or disease, which distinguishes it from delusional infestation. UK psychodermatology practice treats this as an obsessive-compulsive spectrum/body-focused repetitive behaviour, where habit reversal training (awareness training, stimulus control, competing response training) is the behavioural treatment of choice, with SSRIs used as adjunctive pharmacotherapy for associated anxiety, depression or compulsivity. This combined psychological and pharmacological approach addresses the underlying drive to pick rather than just the physical lesions, reducing relapse and skin damage.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions