Дерматилломания: Современные взгляды на диагностику и лечение расстройства самоповреждения кожи.

Excoriation disorder, more commonly known as dermatillomania, is a mental disorder on the obsessive–compulsive spectrum that is characterized by the repeated urge or impulse to pick at one's own skin, to the extent that either psychological or physical damage is caused.

Since the DSM 5 (2013), excoriation disorder is classified as "L98.1 Excoriation (skin picking) disorder" in ICD 10; and is no longer classified in "Impulse control disorder" (f63). Excoriation disorder is defined as "repetitive and compulsive picking of skin which results in tissue damage". There is also a high level of comorbidity between those that have trichotillomania and those that have excoriation disorder. One shared behavior is continued picking as an emotional or reward sensation. This involves the picking to resolve negative thoughts or emotions or a developed behavior of automatic picking. This automatic picking becomes habitual and is a comorbidity with ADHD. In 2018, a new study on Tourette Syndrome (TS), trichotillomania, and excoriation revealed cooccurrence of the same disorders. Participants were screened by clinical staff in clinics supporting patients with Tourette Syndrome. Those patients included then completed self report questionnaires. Of the total number of TS participants (n = 811), 13% revealed diagnosis of trichotillomania and excoriation. This significance of results was reported with the recommendation of screening in children with a diagnosis of TS. This will assist clinicians in screening for trichotillomania and excoriation or the risk factors for both. As with the adult population of women, girls are more impacted by the disorders than boys. Research has also suggested that excoriation disorder may be thought of as a type of obsessive compulsive disorder (OCD). Reviews of treatment of excoriation disorder have shown that the following medications may be effective in reducing picking behavior: doxepin, clomipramine, naltrexone, pimozide, and olanzapine. Topiramate, an anti epileptic drug, has been used to treat excoriation disorder; in a small study of individuals with Prader–Willi syndrome, it was found to reduce skin picking. Several studies have shown that habit reversal training associated with awareness training reduces skin picking behavior in those individuals with excoriation disorder that do not have psychological problems. In an absence of longitudinal data which follows patients with Psychiatric referrals as a result of ED, little is known for the reasons patients do not follow through with the referral, or what more is needed to ensure access to care. Overall, less than 25% of participants in this study achieved long term results, highlighting the need for a collaborative team approach to treatment across several disciplines to include PCP, dermatology, psychology and psychiatry as needed.

Several different behavioral interventions have been tested to treat excoriation disorder in those with developmental disabilities. One method is to have individuals wear a form of protective clothing that limits the ability of the patient to pick at their body, e. g., gloves or face mask.

Typically, individuals with excoriation disorder find that the disorder interferes with daily life. Hindered by shame, embarrassment, and humiliation, they may take measures to hide their disorder by not leaving home, wearing long sleeves and pants even in the heat, or covering visible damage to the skin with cosmetics and/or bandages. When untreated, excoriation disorder can last anywhere from 5 to 21 years. However, many doctors consider this disorder to be a permanent diagnosis. Excoriation has been documented as showing active from an onset in childhood and remaining active through adulthood.

The prevalence of excoriation disorder is not well understood. Excoriation disorder has a high rate of comorbidity with other psychiatric conditions, especially with mood and anxiety disorders
In a 2020 Study of Excoriation to identify the variable's such as: demographics, SES, marital status and gender, more than 75 % of participants were identified as female, more than 45% of all participants were unemployed, and more than 60% had marital status which ranged from being single to divorced or widowed. With females accounting for diagnosis than any other group, future research should look to uncover reasons why women are more impacted by excoriation, and if excoriation has a correlation with marital status or happiness in life.

The first known mention of excoriation disorder in the print can be found in 1898 by the French dermatologist Louis Anne Jean Brocq, describing an adolescent female patient who had uncontrolled picking of acne.

Excoriation disorder has been the subject of several episodes of Obsessed, a television documentary series that focuses on the treatment of anxiety disorders. Excoriation disorder is shown as a symptom of Nina Sayers' anxiety and OCD in the movie Black Swan. During the 2021 Miss America competition, Miss Alaska 2021 Emma Broyles highlighted her vulnerability and openness on social media about having attention deficit hyperactivity disorder and dermatillomania, as well as her history with volunteering for the Special Olympics. She was crowned Miss America 2022.