Thursday, Oct. 19
14:30 – 16:30 (2 hrs)
Meeting Room: Pavilion Ballroom D (3rd floor – North Tower)
Iliana Ortega*, MD, FRCPC
Supported by the Canadian Academy of Child and Adolescent Psychiatry

CanMEDS Roles:

1. Medical Expert
2. Collaborator
3. Health Advocate

At the end of this session, participants will be able to: 1) Identify key points in the presentation of skin-picking disorder with particular focus on children and adolescents; and 2) Describe treatment options and provide clinical pearls of excoriation disorder.

Excoriation (skin-picking) disorder (ED), also known as neurotic excoriation, psychogenic excoriation, or dermatillomania, is described as recurrent picking of skin, leading to skin lesions as well as severe distress or functional impairment for the patient. Due to its overlap in clinical presentation with conditions such as trichotillomania (hair-pulling disorder), ED is listed as one of the obsessive–compulsive and related disorders.

Females are more commonly affected, and the highest burden of the disease for ED happens during adolescence and early adulthood. ED is commonly associated with other psychiatric conditions, such as trichotillomania (hair pulling), obsessive–compulsive disorder, body dysmorphic disorder, attention-deficit hyperactivity disorder (ADHD), tic disorders, anxiety disorders, and depression, among others.
The clinical presentation, including clinical examination and differential diagnosis as well as prevalence, epidemiology, etiology, and pathophysiology for this condition will be reviewed.

The various management approaches will be described, beginning with conservative measures, such as psychoeducation, and progressing to other psychological interventions, such as cognitive-behavioural therapy with a focus on habit-reversal training and other psychological interventions, such as acceptance and commitment therapy and mindfulness training. The existing data on pharmacological interventions, such as the use of selective serotonin reuptake inhibitors, second-generation antipsychotics, N-acetylcysteine, and other off-label drugs will also be reviewed.

References:

1. Schumer MC, Bartley CA, Bloch MH. Systematic review of pharmacological and behavioral treatments for skin-picking disorder. J Clin Psychopharmacol 2016;36(2):147–152.
2. Lochner C, Roos A, Stein DJ. Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatr Dis Treat 2017;13:1867–1872.