Neuropsychocutaneous Disorders

Fixed false belief of being infested with parasites; imaginary parasites typically reported as ‘bugs’ crawling under skin (formication)

{Need to distinguish from substance-induced formication}

Treatment: antipsychotic medication such as pimozide (side effects include extrapyramidal side effects and prolonged QT interval) or risperidone

Excessive concern over perceived defect in body image with ↑↑ time spent checking for imperfections

Spectrum ranges from obsessive to
delusional thinking

Treatment: SSRIs if OCD variant,
antipsychotics if delusional variant

Deliberate creation of self-inflicted cutaneous lesions; lesion morphology variable but often with bizarre geometric shapes with sharp margins

{Typically lesions created to sastisfy an unconscious psychological or emotional need (secondary gain)}

Treatment: topical medication to help with healing; ± antidepressants, antipsychotic or antianxiety medications

Unconscious to uncontrollable picking (either at pre-existing skin lesions or de novo); excoriations with irregular borders

Treatment: treat any underlying cutaneous disease (i.e. acne), antihistamines for pruritus (i.e. doxepin), ± SSRIs

Factitial disorder; painful swollenecchymoses at sites of trauma, often in women with an underlying psychiatric illness

Treatment: difficult