Introduction
The correlation between psychiatric and dermatological disorders is
highly complex, considering etiology, diagnosis, and treatment. The skin
and the nervous system, of which the brain is the central organ, have
the same origin during the formation of the embryo. Both are of
ectodermal origin and, therefore, there is an important interaction
between them [1].
In this scenario, the excoriation disorder (ED), also known as
dermatillomania, psychogenic excoriation, or neurotic excoriation, is
characterized by the recurrent choice of skin, leading to skin lesions
and significant suffering or functional impairment [1,2].
Although documented in the medical literature since the 19th century, ED
has only recently been included as a distinct entity in conventional
psychiatric nosology. In the Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition (DSM-5) and in the proposed International
Classification of Diseases, 11th Revision (ICD-11), ED is listed as one
of the obsessive-compulsive and related disorders (OCRDs), due to its
overlap with conditions such as trichotillomania [3].
Epidemiological data indicated a prevalence of neurotic excoriation of 2
to 3%, in relation to the general population, 2%, among dermatological
patients, and 9%, in patients with pruritus [4]. Lesions are seen
in the places most easily reached by the hands, such as the face and
upper limbs [5]. It affects both sexes in different age groups with
a significant predominance in women. The patient admits to causing skin
lesions repeatedly and frequently, being unable to avoid the repetitive
process, characterizing the compulsion [6].
Emotion finds in the skin a means of physical expression. The records of
the most diverse feelings are marked there in the form of scars. The
lesions of the disease mark the space of a physical and also a
psychological wound, taking the person as a psychosomatic totality
[7].
According to Azambuja (2009) [8], the abrasions do not result from
neurosis, but from a very particular mental process that forces the
person to scrape himself as a form of stress relief, whose energy is
diverted to a repetitive gesture of rubbing, scratching, scratch or
pluck the skin. Scratching is one of the archaic forms of the return of
aggression on the body. In terms of treatment, there is a shortage of
data. However, management currently has a comprehensive psychiatric
examination, behavioral therapy, and medication.
Therefore, the present study addressed the main clinical findings in
research studies on neurotic excoriation, in addition to valuing the
importance of psychological aspects in etiopathogenesis.