Indian Journal of Dental Research

SHORT COMMUNICATION
Year
: 2014  |  Volume : 25  |  Issue : 4  |  Page : 544--545

Dermatillomania: In patient undergoing orthodontic treatment


Adit1, Avesh Sachan2, TP Chaturvedi2, Rahul Agrawal3, Ajit Vikram Parihar2,  
1 Department of Oral Medicine and Radiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
2 Department of Orthodontics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
3 Department of Oral Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Correspondence Address:
Adit
Department of Oral Medicine and Radiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh
India

Abstract

Dermatillomania is a disorder in which a person habitually picks their skin, and this is a form of self-injury. It can involve any part of the body, but usually involves the face, neck, arms and shoulders. Symptoms often follow an event that has caused severe emotional distress. A dermatillomania or compulsive skin picking episode may be a conscious response to anxiety or depression but is frequently done as an unconscious habit. In this case report, a patient undergoing orthodontic treatment was found to be suffering from dermatillomania and was treated using psychological counseling.



How to cite this article:
Adit, Sachan A, Chaturvedi T P, Agrawal R, Parihar AV. Dermatillomania: In patient undergoing orthodontic treatment.Indian J Dent Res 2014;25:544-545


How to cite this URL:
Adit, Sachan A, Chaturvedi T P, Agrawal R, Parihar AV. Dermatillomania: In patient undergoing orthodontic treatment. Indian J Dent Res [serial online] 2014 [cited 2019 Oct 21 ];25:544-545
Available from: http://www.ijdr.in/text.asp?2014/25/4/544/142580


Full Text

Dermatillomania (also known as compulsive skin picking [CSP]) is an impulse control disorder in which the patients unconsciously and repetitively pick at one's own skin, which results in mutilation of healthy skin. [1] Patients affected with dermatillomania find skin picking to be stress relieving, although it is physically as painful as it would be in a non-skin picker. In most cases, dermatillomania affects the healthy skin on an individual's face and neck, but can involve other areas of the body.

The regions most commonly affected are face, gums, lips, neck, back, shoulder, scalp, chest and extremities such as finger nails, cuticles and toe nail. Episodes of skin picking are often preceded or accompanied by tension, anxiety or stress. Patients feel a compulsive urge to pick, bite or scratch the skin, thereby experiencing relief from upsetting emotions. Left untreated, this disorder can impact not only psychological health but physical health as well. [2]

Skin picking is commonly seen in women and typically begins in teenage years. It begins as a conscious way to deal with tension and eventually becomes an unconscious impulse-controlled disorder. Aware of the damage they are causing themselves, many patients recognize a need to stop this habit but are physically and mentally unable to do so.

Although the exact etiology is not known, various causes that have been implicated are:

Stress, anxiety and other psychological factors.Traumatic events, especially in childhood.Heredity (runs in families).Neurological imbalance caused by overloading stress to the nervous system.

Individuals affected tend to hide the signs and symptoms of CSP because of psychological and social embarrassment. Plagued by shame, they may take measures to hide their disorder such as wearing long sleeves, using cosmetics, bandages, etc. [3]

Various forms of treatment have been instituted in an attempt to prevent skin picking. It may involve cognitive and coping skills or in-depth psychological counseling.

In this case report, a patient undergoing orthodontic treatment was found to be suffering from dermatillomania and was treated using psychological counseling.

 CASE REPORT



A 15-year-old female patient who was undergoing orthodontic treatment in our department was found to have a large discoloration of skin on the right side neck region, approximately 2 cm × 2 cm in size [Figure 1] and [Figure 2]. {Figure 1}{Figure 2}

Her medical history revealed that she had neither systemic disease nor mental retardation. It was thought that the patient had a self-inflicted wound to which the patient embarrassingly agreed. It was learned that when she was a little kid and her mother was busy in household activities, she would start pinching her skin to relieve her anxiety and soon it became an unconscious habit. The patient was referred to the Department of Psychiatry for Consultation, where it was determined that an underlying psychological disorder (excessive anxiety) was responsible for this situation.

The patient underwent psychological counseling. It was observed that the lesion on the neck showed improvement in about 2 weeks and was completely healed in about

3 months. She is still participating in the psychotherapeutic treatment in the Department of Psychiatry.

 DISCUSSION



Dermatillomania, or CSP, may be even a pacifier; for example, one may pick their skin while reading a book or watching television. It may result in scarring, excessive scabbing, callusing, bleeding, swelling or discoloration at the site subjected to picking. [4] In extreme cases, an individual may even withdraw from social interaction to hide their disorder. Dealing with dermatillomania first requires an individual to admit that there is a potential mental or physical health problem and seek an appropriate treatment by qualified health professionals. [5]

Diagnosis requires a through physical and psychological evaluation and successful treatment is generally based on individual's signs, symptoms and personal needs. Once the diagnosis is made, it can be treated by medication and psychotherapy.

Currently, no specific medication is used to treat dermatillomania. Drugs that are used to treat obsessive compulsive disorders and anxiety disorder are generally tried. Antidepressants that work by affecting the level of serotonin in brain have found to be effective. It can take up to 12 weeks to relieve the dermatillomania symptoms once the antidepressant treatment starts.

Psychotherapy can also aid in behavior modification through cognitive behavior therapy, which helps an individual realize how the thought process forms and translates into feelings and behavior. It helps to seek out why they are picking at their own skin. [6]

Habit reversal training has been used to treat CSP. It makes the individual aware of unconscious behavior, recognize triggers and modify behavior patterns. Hypnosis and meditation have also been successful in some cases.

 CONCLUSION



The head and neck regions are the most commonly affected areas in dermatillomania patients. A dentist may be the first person to recognize the signs and symptoms of this disorder and therefore should be aware of it.

References

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2Rasmussen P. The congenital insensitivity-to-pain syndrome (analgesia congenita): Report of a case. Int J Paediatr Dent 1996;6:117-22.
3Saemundsson SR, Roberts MW. Oral self-injurious behavior in the developmentally disabled: Review and a case. ASDC J Dent Child 1997;64:205-9,228.
4Hayes SL, Storch EA, Berlanga L. Skin picking behaviors: An examination of the prevalence and severity in a community sample. J Anxiety Disord 2009;23:314-9.
5Snorrason I, Smári J, Olafsson RP. Emotion regulation in pathological skin picking: Findings from a non-treatment seeking sample. J Behav Ther Exp Psychiatry 2010;41:238-45.
6Gupta MA, Gupta AK. Psychodermatology: An update. J Am Acad Dermatol 1996;34:1030-46.