excoriation

Excoriation is the act of scratching or picking at the skin, producing superficial injuries. In dermatology, excoriations are eroded or crusted lesions caused by abrasion from scratching or rubbing, often in response to pruritus or dermatitis. Recurrent excoriation can lead to chronic wounds and scarring.

Lesions are typically linear or punctate and most often appear on exposed areas such as the arms, hands, face, or legs. They may be accompanied by itching, irritation, and a sense of compulsion. When scratching is frequent and distressing, the presentation may be described as excoriation disorder or skin-picking disorder.

Common causes include inflammatory or dry skin conditions (atopic dermatitis, contact dermatitis, xerosis), psoriasis, insect bites, scabies, and other pruritic diseases. Neuropathic itch, stress, and other psychiatric factors can contribute. Secondary infection is a potential complication.

Diagnosis is clinical, based on history and examination, and aims to distinguish primary dermatologic disease from self-inflicted injury. Evaluation may address underlying itch, dermatologic conditions, and possible psychiatric comorbidity.

Treatment focuses on reducing itch, promoting skin healing, and addressing behavior. Emollients and topical anti-inflammatory therapies help control irritation. Behavioral approaches such as habit reversal training and cognitive behavioral therapy are used for excoriation disorder. Medications such as certain selective serotonin reuptake inhibitors or N-acetylcysteine have been studied as adjuncts. Wound care and infection prevention are important during active lesions.

Prognosis varies; early management of itch and behavioral therapies can reduce symptoms and scarring, but chronic or severe cases may persist.