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An excoriation refers to any scratch, shallow cut or lesion on the skin. There can be many causes of an excoriation, including unintentional scratching or rubbing against a rough surface. Certain skin diseases can result in marks on the skin that are classified as excoriations. Finally, there are psychological conditions that can lead a person to intentionally scratch his or her own skin, creating cuts and abrasions. Simple excoriations are easily treated and usually heal quickly.
An excoriation is commonly caused by physical means. This could be the fingernails, a sharp object or a rough surface. An excoriation is different from an open wound because the damage or degradation is restricted to the surface of the skin and does not penetrate deep enough to cause serious bleeding.
There are skin conditions, such as dermatitis and eczema, that can cause the skin to form raised areas or lesions. Chemicals, heat and other agents can cause damage to the skin that does not breach the first layer. All of these skin abnormalities can be classified as excoriations as well.
This term is also used in relation to a condition known as neurotic excoriation. Neurotic excoriation is expressed as compulsive scratching. The compulsion can begin with the appearance a minor lesion on the skin, such as acne. Shortly after, compulsive scratching might begin either consciously or unconsciously and usually is focused on a specific area.
If the compulsive scratching is unconscious, it might be in response to stress or other environmental factors. It could even be the result of a neurological disorder. If the scratching is intentional, it might be because of an underlying psychological problem.
Psychological problems that can cause neurotic excoriation include obsessive compulsive disorder and body dysmorphic disorder. Both of these conditions, as well as many others, can cause an irrational belief that the area being scratched must be modified in some way. In the case of obsessive compulsive disorder, the reason might be a fear of germs. For body dysmorphic disorder, the reasoning might include wanting to remove the lesion or change the shape of the area.
Treatment for basic excoriation involves applying bandages or other coverings along with some topical antibiotics to prevent infections. The wounds can heal quickly because of their superficial nature. Scarring can result from an excoriation, with the damaged areas of the skin healing either lighter or darker than the surrounding area.
Neurotic excoriation can be treated with medications such as selective serotonin reuptake inhibitors. Psychological counseling also is an effective option. Counseling can be used in conjunction with medications.
Skin diseases that cause excoriation are treated individually according to the cause. Creams, ointments and sometimes prescription non-steroidal medications can be used. Over-the-counter histamine blockers, such as allergy medications, might also be effective in some cases.
My sister has this disorder. It started as hair pulling (trichotillomania) and she stopped doing that and has been scratching herself raw for about seven years now. It started with anxiety and panic disorder and now she cannot stop scratching herself.
Psychiatrists, medications, psychologists, biofeedback have been no help. She's 59 years old and she has no life but nervousness and scratching.