Introduction
The correlation between psychiatric and dermatological disorders is highly complex, considering etiology, diagnosis, and treatment. The skin and the nervous system, of which the brain is the central organ, have the same origin during the formation of the embryo. Both are of ectodermal origin and, therefore, there is an important interaction between them [1].
In this scenario, the excoriation disorder (ED), also known as dermatillomania, psychogenic excoriation, or neurotic excoriation, is characterized by the recurrent choice of skin, leading to skin lesions and significant suffering or functional impairment [1,2].
Although documented in the medical literature since the 19th century, ED has only recently been included as a distinct entity in conventional psychiatric nosology. In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and in the proposed International Classification of Diseases, 11th Revision (ICD-11), ED is listed as one of the obsessive-compulsive and related disorders (OCRDs), due to its overlap with conditions such as trichotillomania [3].
Epidemiological data indicated a prevalence of neurotic excoriation of 2 to 3%, in relation to the general population, 2%, among dermatological patients, and 9%, in patients with pruritus [4]. Lesions are seen in the places most easily reached by the hands, such as the face and upper limbs [5]. It affects both sexes in different age groups with a significant predominance in women. The patient admits to causing skin lesions repeatedly and frequently, being unable to avoid the repetitive process, characterizing the compulsion [6].
Emotion finds in the skin a means of physical expression. The records of the most diverse feelings are marked there in the form of scars. The lesions of the disease mark the space of a physical and also a psychological wound, taking the person as a psychosomatic totality [7].
According to Azambuja (2009) [8], the abrasions do not result from neurosis, but from a very particular mental process that forces the person to scrape himself as a form of stress relief, whose energy is diverted to a repetitive gesture of rubbing, scratching, scratch or pluck the skin. Scratching is one of the archaic forms of the return of aggression on the body. In terms of treatment, there is a shortage of data. However, management currently has a comprehensive psychiatric examination, behavioral therapy, and medication.
Therefore, the present study addressed the main clinical findings in research studies on neurotic excoriation, in addition to valuing the importance of psychological aspects in etiopathogenesis.