The Sound of Scratching: An Unusual Cause of Neurotic Excoriations

Neurotic excoriation Itch-scratch cycle Self-inflicted dermatosis D. Parsad, Department of Dermatology, Himalaya Institute Hospital, Dheradun (India) Neurotic excoriations are produced by the patient as a result of repetitive self-excoriation, which may be initiated by an itch or other cutaneous dysesthesia, or because of an urge to excoriate a benign irregularity on the skin. This can initiate and perpetuate the ‘itch-scratch’ cycle, which in some patients becomes a true compulsive ritual [1]. We report an interesting case of neurotic excoriations in which the patient liked to hear the rhythmic sound of scratching produced on her skin. A 19-year-old female presented with mildly pruritic, superficial crusted lesions of 7 months duration. The patient denied any history of psychosocial stress or depression. On examination, the lesions were confined to the extensor surfaces of both forearms including the dor-sum of the hands. The eruption consisted of superficial excoriations varying in diameter from 5 to 10 mm covered at places with sanguineous crusts and having erythematous edges. At few places, pale scars with hyperpigmented borders were noted. On further elicitation of the patient’s urge to scratch, she came forth with the explanation that she enjoyed the sound produced by scratching the skin with her long nails. The patient further admitted that she maintained long nails for this very purpose. Neurotic excoriation, perhaps the commonest of self-inflicted der-matoses, differs from other artefactual conditions in that those who suffer from it readily admit to an uncontrollable urge to gouge and pick at their skin. The most consistent psychiatric disorders reported in association with neurotic excoriations are a personality with per-fectionistic and compulsive traits, obsessive-compulsive disorder and depression [2, 3]. Psychosocial stress has been reported to precede neurotic excoriations in 33-98% of patients [4]. This patient presented with a unique explanation for the urge to scratch her skin. References Freunsgaard K: Neurotic excoriations: A controlled psychiatric examination. Acta Psychiatr Scand 1984;69(suppl):l-52. Gupta MA, Gupta AK, Haberman HF: The self-inflicted dermatosis: A critical review. Gen Hosp Psychiatry 1987;9:45-52. Hatch ML, Pardis C, Friedman S, et al: Obsessive-compulsive disorder in patients with chronic pruritic conditions: Case studies and discussion. J Am Acad Dermatol 1992;26:549-551.