Many if not most skin diseases have an emotional or
psychological component on some level. Sometimes stress
makes the skin disease worse, sometimes the disease itself
causes stress, and sometimes the psychological component
actually can cause the skin disease. SISP can fall into
any of these categories.
In dermatological terms, SISP can be classified into one
of several diagnoses. Most people using this program will
fall into the diagnosis of neurotic excoriations and
excoriated acne. Several other diagnoses will be mentioned
for completeness.
Neurotic excoriations refers to the uncontrollable urge
to pick and dig at the skin. This urge may be unconscious
or may be deliberate in the belief that it corrects some minor
abnormality or surface irregularity of the skin. The picking
creates more pronounced abnormalities so that a vicious cycle is
started. It involves picking, digging or scraping at the skin
persistently often until what is described as a “thread” can be
pulled from the skin. Many old scars, which can be disfiguring,
are visible near areas of active picking. These pickers usually
are middle-aged adults and may be depressed, anxious or
obsessive-compulsive. Women are more likely to be affected
than men.
Excoriated acne occurs usually in girls or young women with
very mild acne or even no acne at all. Often a magnifying mirror
is used to search for minor acne lesions. These minute lesions
are compulsively picked leaving excoriations and scars. This
primarily occurs on the face but can be on the chest or back
as well.
Prurigo nodularis consists of multiple intensely itchy nodules
mostly on the legs and arms. The itching is so severe that lesions
are scratched to the point of causing pea-sized crusted and firm
warty nodules with brown pigmentation. Prurigo nodularis can
occasionally be associated with internal diseases such as HIV
infection or liver disease. Like these other skin diseases it
can be exacerbated by psychological stress, but unlike the others
it is not caused by stress. It occurs mainly in adults with men
and women being affected equally. It can be a chronic disease
lasting for years.
Factitious dermatitis refers to self-inflicted skin lesions
made consciously to simulate a naturally occurring skin
disease. The lesions are made with the fingernails or by some
other mechanical means or by the application or injection of
chemical irritants or caustics. The lesions have a geometric,
bizarre appearance which does not suggest natural causes,
although extensive searches are often done looking for an
organic cause. These patients have an underlying psychopathology
or are true malingerers.
Delusions of parasitosis involves a single fixed delusion of
infestation of the skin with parasites. These patients are so
convinced of their infestation that others believe them as
well. They often bring pieces of skin debris and lint to their
doctor’s appointments in a tissue or jar insisting that the
parasite is contained in their specimen. The skin exam may be
normal or may reveal minor excoriations.
StopPicking.com is intended for those people who suffer from
neurotic excoriation and acne excoriation. Treatment of
prurigo nodularis, factitious dermatitis and delusions of
parasitosis is beyond the scope of this program and a medical
doctor should be consulted if you believe you have any of
these other disorders.