, Jillian W. Wong2 and John Koo3
(1)
Department of Dermatology, University of New Mexico, Albuquerque, NM, USA
(2)
Department of Dermatology, University of California, Davis Sacramento, CA, USA
(3)
Department of Dermatology, University of California, San Francisco, CA, USA
Abstract
Ms. Blackburn is an 83-year-old new patient, who presents with multiple lesions over her arms and legs. She relates a history of volunteering on and off for the past that she began volunteering at a community garden 6 weeks ago, and she has recently been bitten by ants. She states that the lesions from the ant bites have become progressively worse over the past few days. Her lesions have recently demonstrated crusting and weeping of yellow discharge. The patient has come to see the dermatologist because she is concerned about infection of the lesions. She also reports she has recently become very anxious and depressed, as her husband passed away 2 months ago. On physical examination, there are multiple excoriations over the extremities. In addition, during the interview, the patient constantly scratches at her arms and legs.
Ms. Blackburn is an 83-year-old new patient, who presents with multiple lesions over her arms and legs. She relates a history of volunteering on and off for the past that she began volunteering at a community garden 6 weeks ago, and she has recently been bitten by ants. She states that the lesions from the ant bites have become progressively worse over the past few days. Her lesions have recently demonstrated crusting and weeping of yellow discharge. The patient has come to see the dermatologist because she is concerned about infection of the lesions. She also reports she has recently become very anxious and depressed, as her husband passed away 2 months ago. On physical examination, there are multiple excoriations over the extremities. In addition, during the interview, the patient constantly scratches at her arms and legs.
Reflections on the Case
Neurotic excoriations present as self-induced cutaneous lesions often caused by obsessive picking, scratching, rubbing, with or without pruritus being reported. Generally, patients have a strong desire to scratch combined with poor control over these impulses. Common psychiatric disorders associated with neurotic excoriations are anxiety, depression, and obsessive-compulsive disorder. Such behavior can also be related to social stressors. Neurotic excoriations most predominantly occur in women and the average age of onset is in the older adult population, specifically starting during the third to fifth decade [15–17].
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