Updates in the Treatment of Body-Focused Repetitive Disorders

October 2023 | Volume 22 | Issue 10 | 1069 | Copyright © October 2023


Published online September 29, 2023

Cleo Whiting BAa, Sara Abdel Azim MSb, Adam Friedman MD FAADa

aGeorge Washington University Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
bGeorge Washington University Department of Dermatology, Georgetown University School of Medicine, Washington, DC

review concludes that the evidence supporting the beneficial use of NAC for treatment in BFRBs is based upon few trials with small subject sizes and thus should be re-evaluated with larger and longer studies.17

Conclusion
BFRBs can develop into chronic conditions if left untreated, potentially causing scarring, ulceration, disfigurement, alopecia, and severe psychosocial impairment. Early diagnosis and treatment can result in symptom reduction in as many as 50% of individuals.7 Dermatologists play a vital role in recognizing BFRBs as early disease presentations often manifest with skin findings or may be triggered by dermatologic disease.18 Thus, it is essential for clinicians to remain up-to-date on the management and treatment of BFRBs to prevent long-term disability and morbidity.

Disclosure
The authors declare no conflicts of interest.
References

  1. Obsessive-Compulsive and Related Disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association. 2022.
  2. Odlaug BL, Grant JE. Clinical characteristics and medical complications of pathologic skin picking. Gen Hosp Psychiatry. 2008;30(1):61-66. doi:10.1016/j.genhosppsych.2007.07.009
  3. Gee SN, Zakhary L, Keuthen N, et al. A survey assessment of the recognition and treatment of psychocutaneous disorders in the outpatient dermatology setting: how prepared are we?. J Am Acad Dermatol. 2013;68(1):47-52. doi:10.1016/j.jaad.2012.04.007 
  4. Jafferany M, Vander Stoep A, Dumitrescu A, et al. The knowledge, awareness, and practice patterns of dermatologists toward psychocutaneous disorders: results of a survey study. Int J Dermatol. 2010;49(7):784-789. doi:10.1111/j.1365-4632.2009.04372.x
  5. Mansueto CS, Vavrichek SM, Golomb RG. Overcoming Body-Focused Repetitive Behaviors: A Comprehensive Behavioral Treatment for Hair Pulling and Skin Picking. Oakland: New Harbinger Publications. 2020.
  6. Moritz S, Penney D, Missmann F, et al. Self-help habit replacement in individuals with body-focused repetitive behaviors: a proof-of-concept randomized clinical trial [published online ahead of print, 2023 Jul 19]. JAMA Dermatol. 2023;e232167. doi:10.1001/jamadermatol.2023.2167
  7. Grant JE, Chamberlain SR. Trichotillomania and skin-picking disorder: an update. Focus (Am Psychiatr Publ). 2021;19(4):405-412. doi:10.1176/appi. focus.20210013
  8. CBT for Body-Focused Repetitive Behavioral Disorders. Atlanta CBT. Updated 2023. Available at: https://www.atlanta-cbt.com/cognitive- behavioral-therapy-body-focused-repetitive-behaviors/#:~:text=In%20 particular%2C%20the%20CBT%20is, pleasurable%20aspect%20of%20 the%20behavior. Accessed July 20th, 2023
  9. Hoffman J, Williams T, Rothbart R, et al. Pharmacotherapy for trichotillomania. Cochrane Database Syst Rev. 2021;9(9):CD007662. doi:10.1002/14651858.CD007662.pub3
  10. Selles RR, McGuire JF, Small BJ, et al. A systematic review and meta- analysis of psychiatric treatments for excoriation (skin-picking) disorder. Gen Hosp Psychiatry. 2016;41:29-37. doi:10.1016/j.genhosppsych.2016.04.001
  11. Lochner C, Roos A, Stein DJ. Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatr Dis Treat. 2017;13:1867-1872. doi:10.2147/NDT.S121138
  12. Grant JE, Chesivoir E, Valle S, Ehsan D, Chamberlain SR. Double-blind placebo-controlled study of memantine in trichotillomania and skin- picking disorder. Am J Psychiatry. 2023;180(5):348-356. doi:10.1176/appi. ajp.20220737
  13. Greenberg EL, Geller DA. Cautious optimism for a new treatment option for body-focused repetitive behavior disorders. Am J Psychiatry. 2023;180(5):325-327. doi:10.1176/appi.ajp.20230226
  14. Hwang AS, Campbell EH, Sartori-Valinotti JC. Evidence of N-acetylcysteine efficacy for skin picking disorder: A retrospective cohort study. J Am Acad Dermatol. 2022;87(1):148-150. doi:10.1016/j.jaad.2021.06.874
  15. Grant JE, Chamberlain SR, Redden SA, et al. N-Acetylcysteine in the treatment of excoriation disorder: a randomized clinical trial. JAMA Psychiatry. 2016;73(5):490-496. doi:10.1001/jamapsychiatry.2016.0060
  16. Kashetsky N, Wong A, Lam JM, et al. Efficacy of N-acetylcysteine in trichotillomania (hair-pulling disorder), skin-picking disorder, and onychophagia (compulsive nail-biting). J Eur Acad Dermatol Venereol. 2023;37(1):e73-e76. doi:10.1111/jdv.18508
  17. Lee DK, Lipner SR. The potential of N-acetylcysteine for treatment of trichotillomania, excoriation disorder, onychophagia, and onychotillomania: an updated literature review. Int J Environ Res Public Health. 2022;19(11):6370. doi:10.3390/ijerph19116370
  18. Ekore RI, Ekore JO. Excoriation (skin-picking) disorder among adolescents and young adults with acne-induced postinflammatory hyperpigmentation and scars. Int J Dermatol. 2021;60(12):1488-1493. doi:10.1111/ijd.15587

AUTHOR CORRESPONDENCE

Adam Friedman ajfriedman@mfa.gwu.edu
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