Dermatillomania: A Case Report and Literature Review
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The patient is a 58-year-old disabled male, with history of hypertension, type 2 diabetes mellitus, hypertriglyceridemia and lumbar spondylosis. He is an active smoker and smokes approximately a pack of cigarettes daily. He reported compliance to all his medications.

He was also diagnosed with OCD at the age of 26 years but reported compulsive behavior from his adolescence. As an adolescent, he first developed compulsive squeezing of his acne and picking of his facial hair. A few years later, he had to compulsively pick the hair, the acne and skin in his entire body, more so in his legs.

When he presented to the ER, he was found to have an extensive wound on distal left foot with exposure of the underlying muscle tissue, oozing of blood and surrounding erythema.

He had a low-grade temperature of 100.2 F, heart rate of 103 beats/min and blood pressure 133/82 mm Hg. Systemic examination was normal other than sinus tachycardia and the above-described wound.

The patient’s initial baseline laboratory data at the time of admission showed a leukocytosis with a white cell count up to 13,400 per microliter.

He was referred to admission to the general medicine service along with broad-spectrum intravenous (IV) antibiotic coverage (vancomycin and piperacillin/tazobactam) to empirically treat methicillin-resistant Staphylococcus aureus (MRSA), other gram-positive, gram-negative and anaerobic organisms that might be causing the wound infection. The IV antibiotics were given for about 72 hours till the wound cultures were finalized and the blood cultures resulted negative. The wound was also evaluated by general surgery service who recommend topical wound care and management with antibiotics.

Though the prevalence of the skin picking disorder or dermatillomania is unknown, it can lead to severe skin and soft damage and in extreme cases can even lead to hospitalization. Early identification and establishing the diagnosis, enrolling into a non-pharmacological treatment like cognitive behavioral therapy and habit reversal exercises could prevent further complications and permanent damage and disfigurations.