Which are the causes of Dermatillomania?

Dermatillomania, also known as excoriation disorder, does not have a single known cause but is understood as a complex condition resulting from an interplay of genetic, neurobiological, and environmental factors. Current research suggests it involves dysregulation in the brain’s circuits responsible for habit formation, emotional regulation, and impulse control.

What causes Dermatillomania?

Dermatillomania is classified as a Body-Focused Repetitive Behavior (BFRB). While the exact etiology is still under active investigation, experts believe it arises from a "perfect storm" of biological vulnerability and environmental stressors. The brain's reward system, particularly pathways involving dopamine and glutamate, appears to be altered in individuals with Dermatillomania, making the physical act of picking feel temporarily soothing or stress-relieving, even when it leads to significant pain or tissue damage.

Is there a genetic component to Dermatillomania?

Evidence suggests that Dermatillomania has a hereditary component. Research indicates that individuals with a family history of BFRBs, such as trichotillomania (hair pulling) or obsessive-compulsive disorder (OCD), are at a higher risk of developing Dermatillomania. While no single gene has been definitively identified as the cause, geneticists suspect that multiple genes influencing neural signaling may contribute to a predisposition for repetitive behaviors.

What are the primary risk factors and triggers?

It is important to distinguish between the underlying cause and the triggers that initiate a picking episode. Triggers are environmental or internal cues that prompt the behavior in someone already predisposed to the condition. Common factors include:

• Emotional States: High levels of anxiety, stress, boredom, or feelings of guilt.


• Physical Sensations: Detecting an perceived "imperfection" on the skin, such as a scab, bump, or dry patch.


• Environmental Cues: Specific settings, such as standing in front of a mirror or being in a sedentary, quiet environment.


• Comorbid Conditions: A high overlap exists between Dermatillomania and other mental health conditions like depression or OCD.

How is current research improving our understanding?

Medical researchers are currently studying the efficacy of glutamatergic agents, such as N-acetylcysteine, to see if stabilizing brain chemistry can reduce the impulse to pick. By joining the 260 individuals on DiseaseMaps.org who share their experiences with Dermatillomania, patients contribute to a better understanding of how these biological and environmental factors manifest in real-world scenarios.

Next steps

• Consult a board-certified psychiatrist or psychologist specializing in BFRBs.


• Explore evidence-based therapies like Habit Reversal Training (HRT) or Acceptance and Commitment Therapy (ACT).


• Connect with the community at DiseaseMaps.org to share experiences and coping strategies.


• Keep a symptom log to identify your specific emotional or environmental triggers.

Medical disclaimer: This content is for informational purposes only and does not constitute professional medical advice, diagnosis, or treatment.

References

• National Institutes of Health (NIH) - Genetic and Rare Diseases Information Center (GARD)


• The TLC Foundation for Body-Focused Repetitive Behaviors


• Orphanet: Excoriation disorder


• Journal of Clinical Psychiatry: Research on Pharmacological Interventions for BFRBs