{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T04:45:53Z","timestamp":1789447553574,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2020,8,21]],"date-time":"2020-08-21T00:00:00Z","timestamp":1597968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Excoriation disorder is a psychocutaneous disorder characterized by repetitive skin-picking and associated with significant morbidity. Currently, epidemiological data in patients with excoriation disorder are lacking so we sought to characterize common patient demographics and comorbidities. We conducted a retrospective case-control study comparing 250 patients with excoriation disorder with 250 age-, race- and sex-matched controls identified between 2007 and 2019 at a single tertiary care center. We found that the majority of excoriation disorder patients were female (76%), Caucasian (82%) and unmarried (62%), with a mean age of 49 years. Compared to the matched controls, patients with excoriation disorder had increased odds of several psychiatric illnesses, including obsessive compulsive disorder (odds ratio (OR) 28.48, 95% confidence interval (CI): 1.68, 481.75), substance use disorder (OR 24.33, 95% CI: 5.81, 101.77), post-traumatic stress disorder (OR 8.23, 95% CI: 2.24, 129.40), depression (OR 8.19, 95% CI: 4.86, 13.80), bipolar disorder (OR 7.55, 95% CI: 2.22, 25.65), attention-deficit\/hyperactivity disorder (OR 5.63, 95% CI: 1.62, 19.57), and anxiety (OR 5.01, 95% CI: 2.92, 8.62). Only a minority (42%) of patients were given psychiatry referrals and of those referred, a majority (64%) did not follow-up with psychiatry. The outcomes were also generally unfavorable as only 21% of patients experienced a resolution or improvement in their symptoms. This highlights the need for a multidisciplinary approach to manage patients with excoriation disorder, involving both dermatologists and psychiatrists.<\/jats:p>","DOI":"10.3390\/jcm9092703","type":"journal-article","created":{"date-parts":[[2020,8,21]],"date-time":"2020-08-21T09:21:51Z","timestamp":1598001711000},"page":"2703","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Epidemiology and Comorbidities of Excoriation Disorder: A Retrospective Case-Control Study"],"prefix":"10.3390","volume":"9","author":[{"given":"Christina","family":"Kwon","sequence":"first","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishadh","family":"Sutaria","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7542-1016","authenticated-orcid":false,"given":"Raveena","family":"Khanna","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8625-0083","authenticated-orcid":false,"given":"Erik","family":"Almazan","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyle","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noori","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarina","family":"Elmariah","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3736-1515","authenticated-orcid":false,"given":"Shawn G.","family":"Kwatra","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"351","DOI":"10.2165\/00023210-200115050-00002","article-title":"Psychogenic excoriation. Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment","volume":"15","author":"Arnold","year":"2001","journal-title":"CNS Drugs"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.jaad.2009.03.038","article-title":"The psychiatric profile of patients with psychogenic excoriation","volume":"61","author":"Mutasim","year":"2009","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jaad.2009.11.592","article-title":"Neurotic excoriations","volume":"63","author":"Brodin","year":"2009","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4","DOI":"10.2340\/00015555-1506","article-title":"Self-inflicted lesions in dermatology: Terminology and classification\u2014A position paper from the European Society for Dermatology and Psychiatry (ESDaP)","volume":"93","author":"Gieler","year":"2013","journal-title":"Acta Dermeto Venereol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"454","DOI":"10.4088\/JCP.v60n0707","article-title":"Self-injurious skin picking: Clinical characteristics and comorbidity","volume":"60","author":"Wilhelm","year":"1999","journal-title":"J. Clin. Psychiatry"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.janxdis.2009.01.008","article-title":"Skin picking behaviors: An examination of the prevalence and severity in a community sample","volume":"23","author":"Hayes","year":"2009","journal-title":"J. Anxiety Disord."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.comppsych.2009.04.003","article-title":"The prevalence of pathologic skin picking in US adults","volume":"51","author":"Keuthen","year":"2010","journal-title":"Compr. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.comppsych.2014.12.008","article-title":"Excoriation (skin-picking) disorder in adults: A cross-cultural survey of Israeli Jewish and Arab samples","volume":"58","author":"Leibovici","year":"2015","journal-title":"Compr. Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Torales, J., D\u00edaz, N.R., Barrios, I., Navarro, R., Garc\u00eda, O., O\u2019Higgins, M., Castaldelli-Maia, J.M., Ventriglio, A., and Jafferany, M. (2020). Psychodermatology of skin picking (excoriation disorder): A comprehensive review. Dermatol. Ther.","DOI":"10.1111\/dth.13661"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.clindermatol.2018.08.008","article-title":"Assessment and treatment of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder","volume":"36","author":"Jones","year":"2018","journal-title":"Clin. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, DSM-5; American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"509","DOI":"10.4088\/JCP.v59n1003","article-title":"Characteristics of 34 adults with psychogenic excoriation","volume":"59","author":"Arnold","year":"1998","journal-title":"J. Clin. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"336","DOI":"10.5152\/npa.2015.9902","article-title":"Psychiatric Features in Neurotic Excoriation Patients: The Role of Childhood Trauma","volume":"52","author":"Yildirim","year":"2015","journal-title":"Noro Psikiyatri Ar\u015fivi"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1111\/j.1365-4632.2009.04372.x","article-title":"The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: Results of a survey study","volume":"49","author":"Jafferany","year":"2010","journal-title":"Int. J. Dermatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/j.2041-210x.2012.00250.x","article-title":"Review of alternative approaches to calculation of a confidence interval for the odds ratio of a 2 \u00d7 2 contingency table","volume":"4","author":"Ruxton","year":"2012","journal-title":"Methods Ecol. Evol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. Royal Stat. Soc. Ser. B (Methodol.)"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1111\/sjop.12545","article-title":"Physicians\u2019 gender bias in the diagnostic assessment of medically unexplained symptoms and its effect on patient\u2013physician relations","volume":"60","year":"2019","journal-title":"Scand. J. Psychol."},{"key":"ref_18","unstructured":"Smith, E.C. (2011). Gender-biased Diagnosing, the Consequences of Psychosomatic Misdiagnosis and \u2018Doing Credibility, Occidental College Sociology Student Scholarship."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jbtep.2008.07.002","article-title":"The Milwaukee Inventory for the Dimensions of Adult Skin Picking (MIDAS): Initial development and psychometric properties","volume":"40","author":"Walther","year":"2009","journal-title":"J. Behav. Ther. Exp. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/j.brat.2008.06.006","article-title":"Styles of pulling in youths with trichotillomania: Exploring differences in symptom severity, phenomenology, and comorbid psychiatric symptoms","volume":"46","author":"Flessner","year":"2008","journal-title":"Behav. Res. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"215","DOI":"10.4103\/0378-6323.33632","article-title":"Etiopathogenesis of pruritus due to systemic causes: Implications for treatment","volume":"73","author":"Khopkar","year":"2007","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1097\/SMJ.0b013e3181fa73ef","article-title":"Psychocutaneous disorders: A survey study of psychiatrists\u2019 awareness and treatment patterns","volume":"103","author":"Jafferany","year":"2010","journal-title":"South. Med. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"341","DOI":"10.4088\/JCP.v58n0802","article-title":"A double-blind trial of fluoxetine in pathologic skin picking","volume":"58","author":"Simeon","year":"1997","journal-title":"J. Clin. Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1176\/appi.psy.42.4.314","article-title":"Fluoxetine in pathologic skin-picking: Open-label and double-blind results","volume":"42","author":"Bloch","year":"2001","journal-title":"Psychosomatics"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1097\/JCP.0b013e3181e617a1","article-title":"A double-blind, placebo-controlled trial of lamotrigine for pathological skin picking: Treatment efficacy and neurocognitive predictors of response","volume":"30","author":"Grant","year":"2010","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/YIC.0b013e32809913b6","article-title":"Open-label escitalopram treatment for pathological skin picking","volume":"22","author":"Keuthen","year":"2007","journal-title":"Int. Clin. Psychopharmacol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.genhosppsych.2016.04.001","article-title":"A systematic review and meta-analysis of psychiatric treatments for excoriation (skin-picking) disorder","volume":"41","author":"Selles","year":"2016","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1192\/bjp.bp.114.155192","article-title":"Abnormal brain activation in excoriation (skin-picking) disorder: Evidence from an executive planning fMRI study","volume":"208","author":"Odlaug","year":"2016","journal-title":"Br. J. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.pscychresns.2017.09.006","article-title":"A structural MRI study of excoriation (skin-picking) disorder and its relationship to clinical severity","volume":"269","author":"Harries","year":"2017","journal-title":"Psychiatry Res. Neuroimaging"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1001\/jamapsychiatry.2016.0060","article-title":"N-Acetylcysteine in the Treatment of Excoriation Disorder: A Randomized Clinical Trial","volume":"73","author":"Grant","year":"2016","journal-title":"JAMA Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.2147\/NDT.S121138","article-title":"Excoriation (skin-picking) disorder: A systematic review of treatment options","volume":"13","author":"Lochner","year":"2017","journal-title":"Neuropsychiatr. Dis. Treat."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/2703\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:04:39Z","timestamp":1760177079000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/9\/2703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,21]]},"references-count":31,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9]]}},"alternative-id":["jcm9092703"],"URL":"https:\/\/doi.org\/10.3390\/jcm9092703","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,21]]}}}