Excoriation Disorder in Children - An Obsessive Mental Health Condition

Introduction

Children or adults, everyone picks their skin at some point in their life. It is common for adults to pick at their skin to remove scabs, squeeze blackheads, or pop pimples. However, excoriation disorder is a recurring mental health disorder in children or adults. Skin picking is a body-focused repetitive habit that starts during adolescence, 13 to 15 years, during or after puberty. It can also develop in adults or children. This article describes excoriation disorder in children.

What Is Excoriation Disorder in Children?

The condition is also known as chronic skin-picking disorder or dermatillomania. It is a mental health disorder that makes children pick their skin continuously until it ruptures and bleeds. The incidence of excoriation disorder in children is 2 % to 9 %. Children develop the habit of skin-picking so much that it causes pain or injury spots on the skin. The children often cannot quit the habit voluntarily and do not realize what they are doing.

The children pick on healthy skin, minor skin irregularities, open wounds, blisters, or other lesions. Skin-picking is a chronic condition, with periods of no picking alternating with intense skin-picking. If other people notice the skin damage, it causes shame and embarrassment to the child.

If the habit remains untreated, it may intermittently manifest for weeks, months, or years. The child may spend a lot of time skin-picking. Children can use their fingernails or tools like tweezers or pins to pick their skin.

What Diseases Co-occur With Excoriation Disorder in Children?

Some of the co-occurring medical conditions are:

• OCD (Obsessive-Compulsive Disorder).

• Trichotillomania (hair pulling).

• Onychophagia (nail-biting).

• Depression.

• Anxiety disorder.

• Bipolar disorder.

• Prader-Willi syndrome (genetic disorder).

What Is the Difference Between Obsessive-Compulsive Disorder and Excoriation Disorder?

Although the disorder is a DSM-V (a compendium of psychiatric diagnoses), a type of obsessive-compulsive disorder, there are some differences in characteristics.

The differences are:

• Obsessions: OCD includes obsessions not seen in excoriation disorder.

• The Feeling of Reward: Children with excoriation disorder feel relief or positive emotions after picking their skin, which is not present in OCD.

• Self-Harm: OCD is rarely associated with self-injury or damage, but self-harm is common in excoriation disorder.

What Causes Excoriation Disorder in Children?

There is no known specific cause for developing excoriation disorder in children. However, the factors contributing to the development of excoriation disorder in children are stress, anxiety, anger, boredom, or self-disfigurement. Most children with a family history of the disease develop the disorder. They continue the habit because it makes them feel good. Research has shown dopamine to be involved in skin-picking. Additionally, there is evidence that children with excoriation disorder have differences in brain areas responsible for learning or habit formation.

The causes include:

• The child tries to disfigure themselves to reduce their attractiveness due to their behavior and mental and emotional attitudes.

• Children with a rash, skin infection, or injury may pick those areas. As a result, the wound is aggravated, which hinders healing.

• Children may indulge in skin-picking to cope with their dominating parents.

• They think skin-picking is a mechanism for coping with stress and anxiety. When stressed, the child may absent-mindedly pick on scabs or skin surrounding nails. Therefore, it helps in relieving stress.

• Some children might pick their skin, thinking it to be contaminated.

What Are the Symptoms of Excoriation Disorder in Children?

Excoriation disorder can cause scabs, bleeding, scars, or infection to develop at the site of skin-picking. Children may choose the same location again or alternate between locations. Excoriation disorder severity in children can vary from mild to severe.

Skin picking is an automatic body movement. Most children spend at least an hour skin-picking. Children with severe cases of skin-picking can spend several hours a day indulging in the habit. Some children might not even realize the habit, while others are aware of it but cannot avoid it.

The face is the primarily affected area among children with this disorder. Other affected areas include the legs, back, arms, gums, scalp, lips, shoulder, chest, stomach, fingernails, toenails, and cuticles. Children may pick on rough skin, blemishes, or irregularities.

The picking habit on the skin can be short-duration or constant. Some children who pick their skin try to halt the habit when skin lesions develop. However, the child frequently struggles to break the habit, which causes anxiety.

How Is Excoriation Disorder Diagnosed in Children?

The disorder is diagnosed by analyzing the skin lesion and the child’s behavior.

The signs that help diagnose excoriation in children are:

• The children must have picked their skin to the extent of causing wounds.

• The child must have tried to stop the habit but could not.

• The picking must have affected the child’s routine or caused them upset.

• The condition should not be due to medical or dermatological conditions.

• The characteristics are not described with other psychological conditions.

How Is Excoriation Disorder in Children Treated?

Most children with excoriation disorder fail to get adequate treatment.

Treatment for children with Excoriation disorder includes:

• Medications: Antidepressants with cognitive behavior therapy are beneficial for the child. Among them, Selective Serotonin Reuptake Inhibitors (SSRIs) such as Prozac can reduce obsessive and compulsive behavior in children. Studies are ongoing regarding the efficacy of Lamotrigine (anticonvulsants), Naltrexone (opioid-blocking medications), and N-acetyl cysteine (supplements) for treating excoriation disorder in children.

• Cognitive-Behavioral Therapy: It helps the child to become aware of situations or feelings that trigger skin picking. The therapy helps the child cope with those feelings through other mechanisms. Some of the common cognitive behavioral therapy types are habit reversal training (HBT) and comprehensive behavioral model (ComB).

1. Habit Reversal Therapy: The therapist helps identify events, stressors, or other factors that can trigger skin picking. Based on these findings, the therapist will find alternative activities instead of skin-picking, such as squeezing a rubber ball. Therefore, it helps relieve stress and keep the child’s hand occupied.

• Stimulus Control: Changes are made to the child’s environment to prevent skin picking. For example, the wound is covered with Band-aids or gloves to stop skin picking.

• Surgery: Skin picking can be severe in some children. It causes new extensive wounds or reopens old ones. Such wounds are treated with surgery or skin grafting to treat skin damage.

Conclusion

Excoriation disorder in children is a mental health condition that causes significant distress for the child. Children with excoriation syndrome develop the habit of picking skin, which can harm and induce pain. Seeking professional help can help the child overcome the disorder and get appropriately treated. Most children, after treatment, can lead a healthier life.