Excoriations and ulcers on the arms and legs
Neurotic excoriations
Neurotic excoriations, sometimes referred to as neurodermatitis, are a result of a psychodermatologic disorder in which patients inflict excoriations and ulcers on their skin and admit to their involvement.3 The condition is characterized by excoriations similar in size and shape that are localized on areas easily reached by the patient, such as the arms, legs, and upper back.
The lesions may present in various stages, varying from dugout ulcers to ulcers covered with crusts and surrounded by erythema to areas receding into depressed scars. These lesions are a result of repetitive scratching and digging by the patient, usually without an underlying physical pathology but sometimes initiated by pruritus.1,2
Studies show the condition primarily affects women, with a mean onset between the ages of 30 to 45 years.1 Common psychiatric problems associated with neurotic excoriations include significant social stress, depression, anxiety, and obsessive-compulsive disorder.
Diagnosis: Neurotic excoriations due to depression and stress
The patient’s history and physical examination suggests a diagnosis of neurotic excoriations due to the characteristics of the excoriations and ulcers on her arms and leg, her admission of their self-inflicted nature, and the associated depression and psychosocial stress.
Laboratory tests
Although there are no available laboratory tests to confirm a positive finding of neurotic excoriations, tests could be performed to disprove any systemic causes of pruritus and the resulting dermatological damage.5 These tests include complete blood count with differential, chemistry profile, determination of thyroid-stimulating hormone levels, fasting plasma glucose level, and skin biopsies.1,
Laboratory tests for systemic causes of pruritus should be based on the patient’s physical and history, avoiding a broad approach.
Treatment: address the skin and the psyche
The treatment of neurotic excoriations requires a dual approach, addressing both the dermatological problems and the underlying psychological disorder.3 Supportive dermatologic care is necessary to avoid secondary complications and to ensure that the patient feels supported.3
