Skin picking disorder: what can we learn from such a topical issue?

Abstract

Summary

Skin picking disorder (SPD) is a psychodermatological condition characterised by repeated pathological picking of the skin, creating recalcitrant excoriated skin lesions. As well as the physical manifestations of skin picking, SPD carries with it a host of debilitating social, psychiatric and medical sequelae, which greatly impairs quality of life in sufferers. It is clinically challenging to make an accurate diagnosis of SPD and, in our experience, successful management requires a sensitive and holistic biopsychosocial approach involving a psychodermatology multidisciplinary team.

Relevance

The prevalence of SPD is ~2-4%, yet fewer than 20% of sufferers feel their clinician ‘knew much’ about their condition. This must be immensely frustrating for sufferers, and it chimes with research suggesting that medical students, and by extrapolation doctors, have multiple gaps in their knowledge of psychiatric disorders, patients and treatments. We believe that a greater emphasis on psychiatry in medical training is long overdue, particularly to highlight the crucial importance of addressing psychosocial factors alongside physical symptoms in all patients.

Take Home Messages

1. SPD is an under-diagnosed and often poorly managed condition that is associated with clinically significant distress or impairment in multiple areas of day-to-day functioning.
2. Given the wide differential diagnosis for SPD, a careful history, and physical and mental state examination, is critical in making an accurate diagnosis.
3. SPD lacks a standardised treatment protocol, but successful management can be achieved through involvement of a psychodermatology multidisciplinary team.

Psychosocial illness is poorly understood by the typical medical undergraduate. Medical schools must strive to remedy this by placing a greater emphasis on the importance of holistic assessment and treatment in all patients.