Compulsive Skin Disorders

Psychological stress can lead to various skin disorders, and dermatological conditions can induce psychological symptoms. There are several disorders which can be defined as “compulsive skin disorders” that include several dermatological diseases having the characteristics of compulsiveness and obsessive thoughts. Patients with these compulsive skin disorders cannot prevent themselves from performing a certain action in a repetitive and purposeless way. Considering that patients with compulsive skin disorders usually have a diagnosis and go into psychiatric follow-up and treatment only 8–10 years after the onset of initial signs and symptoms, it is very important to early recognize these disorders. In this chapter, the principal compulsive skin disorders are described and discussed (prurigo nodularis, lichen simplex, acne excoriée, trichotillomania, trichotemnomania, trichoteiromania, onychophagia, onychotillomania, factitious cheilitis, morsicatio buccarum, and pseudo-knuckle pads). Each disorder is characterized, its diagnosis outlined, and management strategies discussed, emphasizing the need for a multidisciplinary approach involving dermatology and psychiatry. In all these conditions, the diagnostic process involves ruling out medical causes and considering the patient’s psychological history and treatment focuses on addressing underlying psychiatric conditions and managing pruritus.