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Dermatophagia
Dermatophagia differs from excoriation disorder in that the repetitive motion sufferers partake in is the biting of the skin.

It has been proposed that dermatodaxia would be a more fitting term for this disorder, as the suffix '-phagia' implies that the skin is being eaten rather than simply bitten. In most cases of dermatophagia, the skin is only bitten with no consumption. In herpetology, dermatophagia is used to correctly describe the act in which amphibians and reptiles eat the skin they shed, but this is not what occurs in humans. Those suffering from this disorder do not develop wounds on the bitten areas of their hands or lose any skin. Instead, they experience a thickening of the skin being repeatedly bitten. This information implies that the skin is simply being bitten and chewed rather than eaten.

General Information
It is important to note that some degree of skin picking is normal in all humans, but those suffering from excoriation disorder spend a majority of their days picking at their skin. Skin picking is classified as an excoriation disorder when they begin to inhibit a person's daily functioning.

The average age of onset for this disorder is 15-45, and there seems to be no particular life stage in which this disorder most commonly manifests.

This disorder has been shown to affect anywhere from 1.4%-5.4% of people

It is commonly reported more by women than men.

If left untreated, the disorder can last from anywhere between 5-21 years, though most doctors consider it an indefinite disorder.

Due to the fact that psychodermatology is a relatively new field, there is no universally accepted term for excoriation disorder.

Excoriation disorder became an official diagnosis with the release of the DSM-5. The diagnostic criteria are as follows :


 * 1) Repeated picking of the skin, resulting in injuries of the skin
 * 2) Attempting to stop repeatedly
 * 3) Picking causes a substantial amount of distress and substantially impairs everyday functioning
 * 4) The picking is not caused by physiological effects of a substance or a comorbid medical disorder
 * 5) The picking is not more accurately attributed to another mental disorder

Excoriation Disorder Etiology
Psychological view: Some psychologists pose that this disorder and the behaviors linked to it has to do with a combination of different stressors and the interaction between these stressors and the individual's ability to respond to these stresses. The belief is that the individual has a impaired ability to handle stressors. The behavior of picking at one's own skin is triggered by boredom, anxiety, stress, or physical sensations such as a feeling of unevenness on the skin.

Neurological: There are no neuroimaging studies to either confirm or deny that skin picking is related to neurological deficiencies

Comorbidity: There are a large amount of literary sources who have questioned if skin picking is due to other disorders. Diagnoses commonly associated with skin picking are eating disorders, bipolar disorder, attention-deficit hyperactive disorder (ADHD), anxiety disorder, body dysmorphic disorder (BDD), and obsessive-compulsive disorder (OCD). Not all motivations for those who receive a diagnosis for their skin picking disorder are the same, especially with people with other diagnosed disorders. People who have a dual diagnosis of OCD and excoriation disorder feel that picking can reveal fears of contamination of the skin. People with BDD claim that the picking is due to imperfections of the skin.

Excoriation disorder sufferers commonly also have diagnoses of multiple skin diseases in their life, a history with skin disease (or multiple diseases), and the concern over dermatological symptoms that cannot be observed by medical professionals.

Comorbidity continued: A link between Pruritus and skin picking disorders? (Incomplete thought, edit ASAP)

Heritability: (Twin study)

Genetic component:

There is no significant evidence to suggest that skin picking disorders are due to inherited traits or genes, though there have been multiple small studies with similar conclusions in regards to the SAPAP3 gene. Excessive grooming by mice has been observed by researchers after deletion of the SAPAP3 gene. This observation lead researchers to study the effects of the SAPAP3 gene on patients with trichotillomania--a disorder marked by the same behaviors directed at ones own head and body hair. This study revealed a significant link between a single nucleotide polymorphism (SNP) within the SAPAP3 gene and trichotillomania.

Drugs: A common adverse side effect of the stimulant drugs lisdexamfetamine mesilate and methylphenidate XR--medications used to treat ADHD in adults--is the development of dermatillomania.

Childhood Trauma: Clinical studies have posited that there is a strong link between traumatic childhood events and excoriation disorder. Those with self-injurious disorders of the skin are found to also frequently report childhood sexual abuse. While attempting to produce diagnostic criteria for excoriation disorder, researchers conversed with 10 patients with the disorder and found that a majority reported personal problems before the picking began, and 4 reported on abuse they suffered in childhood or adolescence.

Childhood onset: A study conducted in 2007 found that 47.5% of those diagnosed with childhood onset skin picking (before the age of 10) pick at their skin into adulthood. The subjects diagnosed childhood onset excoriation disorder are more likely to pick unconsciously at their skin and are less likely to seek treatment than those diagnosed in adulthood.

Treatments:
It is typical for sufferers of excoriation disorder to repeatedly attempt to stop picking, though these attempts often result in relapses. This can lead to shame, anxiety, and depression. These relapses also lessen the affected person's motivation for seeking treatment. Other reasons those with excoriation disorder may not seek treatment is due to the incorrect belief that their picking is simply a bad habit and thus untreatable instead of a disorder.

General overview of therapies: Habit Reversal, Cognitive Behavioral Therapy (most common for BFRBs), Acceptance-Commitment Therapy (ACT), Acceptance-enhanced behavioral therapy

Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is currently the most widely used therapy technique for skin picking disorders. One study performed at Radboud University Nijmegen, Netherlands and showed hope for the treatment of excoriation with CBT. 6 masters-level psychologists administered 45-minute talk and behavioral therapy over the course of 5 weeks. 30 patients were treated with this method, and an unknown amount of individuals suffering from excoriation disorder were placed on a waitlist as the control. All treatment given was done according to a manual partially based on a six-session behavioral therapy treatment plan and partially on a cognitive therapy treatment plan. These two methods were chosen due to their shared success in treating patients with trichotillomania. During these sessions, emphasis was placed on thoughts that lead to the initiation of the picking behavior and worsening of the picking already being performed. Patients were encouraged to replace these thoughts with more useful. Another aspect of treatment which received heavy emphasis was on enhancing the patient's awareness of the skin picking as well as the therapist and patient deciding on an appropriate intervention during a picking episode (such as wearing thick gloves or wrapping bandages around the tips of fingers). There was significant improvement of the duration, amount, and severity of those who underwent treatment and no change in the control group. 71% of patients in treatment reported they picked at their skin at least twice daily at the first intake appointment, and after 5 weeks of treatment only 36% of those same patients reported picking at their skin twice daily. Most importantly, treatment effects seemed to be maintained at a two-month follow-up appointment administered. CBT is found to be most helpful for people who have a dual diagnosis of either body dysmorphic disorder or major depression.

Dance/Movement Therapy
An incredibly new form of treatment for excoriation disorders is the implementation of dance and movement therapy. Dance and movement therapy is the utilization of movement to promote social integration with a focus on emotional and physical wellbeing. Dance and Movement Therapy paired with a positive psychology and solution-focused approach has shown to be a potentially effective treatment for those suffering from excoriation disorders. One researcher notes that the treatment and disorder have many similarities; one of the key similarities being a body-focused component. This researcher also notes that those undergoing this treatment may have an unconscious somatic response to this form of therapy, causing them to have a large amount of success with treatment. While dance and movement therapy has proven to be effective on its own in regards to other disorders (depression and anxiety, most notably), pairing it with positive, solution focused therapy increases its efficacy. It can also be administered in either a group or individual setting, depending on the needs of the patient.

Case Study: Movement Therapy
Five dance and movement therapists along with five members of the Trichotillomania Learning Center underwent a study in which the patients were interviewed by dance and movement therapists after attending a session of dance and movement therapy. While the study was relatively small and non-longitudinal, there was a common trend among participants who experienced relief from their session and expressed a desire to continue treatment if available. Dance and movement therapy allowed patients to develop a new relationship with their impulses, accepting them for what they were instead of experiencing distress when said urges arise. It also provided a grounding sensation for some participants, who said they felt calmed by dance and movement therapy. The participants in this study unanimously agreed that this form of therapy would be most effective in a long term setting, though they did experience short-term relief.

Drug Therapy:
Antipsychotic, antianxiety, antidepressant, and antiepileptic medications have all been used to treat skin picking, with varying degrees of success. In a meta-analysis of pharmacological treatments of excoriation disorders, it was found that Selective Serotonin Reuptake Inhibitors (SSRIs) and lamotrigine were no more affective than a placebo.

Treatment for Dermatophagia
There is no therapy known to effectively treat dermatophagia, however there have been attempts at stopping sufferers from being able to chew on their skin. One notable method that is currently in development is focused on in curbing dermatophagia in children with cerebral palsy. This method is known as the PLAY (Protecting Little and Adolescent hands) hands protective glove. This method of intervention involves small, non-invasive plastic brackets being placed around the affected fingers. These brackets do not hinder movement or tactile feedback, and they are constructed from non-toxic durable plastic that can withstand the force of chewing. Presently PLAY hands protective gloves exist in concept and prototype only, but this intervention method could improve the quality of life of those suffering from CP-induced dermatophagia.