What is dermatillomania and why obsessive attention to one’s own skin can become uncontrollable

What is dermatillomania and how does it manifest?

Experts call dermatillomania obsessive behavior aimed at the skin: scratching wounds, squeezing out inflammations, combing uneven skin, picking off hangnails, biting the lips and cheeks from the inside.

There are actually many more such examples - they all belong to a large group of body-focused repetitive behavior disorders (BFRB - body-focused repetitive behavior). Along with dermatillomania, it also includes trichotillomania (uncontrolled hair pulling), onychophagia (obsessive biting of nails and cuticles), rhinotillexomania (the need to pick the nose and damage its mucous membrane).

With dermatillomania, open areas of the body most often suffer, or rather, those to which there is direct access - the face, head, hands. But it also happens that a person injures his back, chest, and the front of his legs.

Treatment

Condylomas and HPV require a systematic approach to treatment.

Medication

To combat condylomas in women and men, doctors act in three directions:

• against viruses;
• in order to increase immunity;
• for fortification of the patient.

Cycloferon and inosiplex act against HPV activation and its reproduction. Inferon and allokin-alpha stop viruses and help restore the immune system. To improve the general health of women and men, Immunal, Amixin, Poludan, etc. are prescribed. A complex of vitamins and minerals is also an essential component of treatment for condylomas.

Local

Condylomas are successfully treated using ointments and sprays of antiviral action (epigen-intim, condylen, etc.). Women and men will not have to think about condylomas if they are treated with inquimod, podophyllotoxin. For pregnant women, you can use trichloroacetic and nitric acids. Women need to fight condylomas in stages: first remove them, and then, or in parallel, act to reduce the number of viruses. Often (in every third woman) condylomas enter the stage of relapse (especially if preventive measures are not followed and the recommendations of the attending physician are ignored).

Removal

Methods for removing condylomas in modern medicine are varied:

• Electric coagulation. This method has disadvantages - many contraindications, painful procedure and long recovery.
• Cryotherapy. Condylomas are removed using liquid nitrogen. The positive aspects of this technique are the absence of scars, painless effects, and the absence of anesthesia.
• Surgical method. The growths are removed during surgery, and stitches are placed at the site of the wounds. Doctors use local anesthesia.
• Use of chemicals. This method is contraindicated during pregnancy and lactation.
• Laser therapy. Condylomas are removed with a laser beam; this is a treatment that does not affect healthy cells and leaves virtually no scars.
• Radiosurgical method. The use of a special device helps remove condylomas without contact with the body. Removal of growths is accompanied by simultaneous sealing of blood vessels. This technique is one of the most modern and in demand.

Dermatillomania and perfectionism

The fact that people most often focus on exposed areas of the body has led researchers to believe that dermatillomania is triggered by the desire to achieve an ideal appearance (for example, to eliminate a certain “flaw”). As a result, comprehensive skin care can take on inadequate forms over time.

Ira Polevaya blogs about dermatillomania on Instagram. She has lived with the disorder for eight years and associates its appearance in adolescence with the attitudes of “ideality” that were broadcast by fashion glossy:

“When I was 10 years old, I started collecting women’s teen magazines, where all the models are presented with perfect retouched skin. So a strange attitude arose in my head: “I must have perfect skin, otherwise there is no other way.” To me, it felt like a vital commitment, like knowing how to breathe.

But at the age of 12, as luck would have it, I started getting small rashes on my face, and it knocked me off my feet. I decided to get rid of these “imperfections” on my own: I crushed them and pierced them. At the same time, I tried to treat my skin the normal way, but the sight of an unpopped pimple forced me to resort to the old “bloody methods.” This dragged on for 8 years. At 17, an exacerbation began: I picked my cheek very badly, a large pink spot remained, and I began to fear that it would always be like this. This means that I will never be able to get closer to a non-existent ideal.”

Other girls also agree with the idea that beauty culture, Instagram fetishes, lookism and other stereotypes around appearance can influence the development of dermatillomania in adolescents:

“Photoshopped photos can create the erroneous impression that everyone around you has perfect skin without flaws,” says Yulia.

But the idealized image of skin in popular culture is just the tip of the iceberg. Researchers believe that the causes of dermatillomania lie deeper and have an individual background: the special biological sensitivity of the nervous system and anxiety that arises in childhood.

Modern methods of treating genital warts

Genital warts (synonyms: condylomata acuminate, viral condylomas, genital warts, genital warts) are diseases caused by the human papillomavirus (HPV). Diseases caused by HPV are among the most common contagious viral infections in humans. HPV is a small, round, double-stranded DNA virus with a diameter of 50 to 55 nm. To date, more than 80 types of HPV have been described (Table 1). Infections caused by HPV are highly specific to the epidermis, since HPV has a tropism for epithelial cells of the skin and mucous membranes.

Genital warts are highly contagious. Infection occurs through contact, most often sexually. The virus can survive for a long time on infected objects. Small abrasions, cracks or abrasions serve as entry points for the virus. The virus can also spread by autoinoculation. Lack of personal hygiene, wearing tight underwear, maceration of folds in obese people, as well as immunodeficiency conditions contribute to the development of lesions over a large area of ​​the skin.

Over the past 20 years, there has been an increase in the incidence of genital warts. In the United States, genital warts (or genital warts) are one of the most common sexually transmitted diseases. The incidence of genital warts exceeds 106.5 cases per 100 thousand US population, which is about 0.1% of the entire population [1]. Close attention to this disease is explained by the fact that some of the types of HPV that cause genital warts can lead to malignancy of the process. The most potentially dangerous are types 16 and 18. It is no coincidence that it is important to promptly diagnose and treat genital warts. Recurrence of genital warts is not always associated with re-infection, but can be caused by reactivation of the virus.

Clinical picture. The incubation period lasts from 3 weeks to 6 months and averages about 2.8 months. Men and women are equally susceptible to this disease. The average age of patients ranges from 22 to 25 years.

Typically, genital warts are localized on the genitals and in the perianal area. In HIV-infected patients, genital warts may appear in unusual places, such as the face, eyelids, and ears. In men, the most common locations are the penis, urethra, scrotum, perianal, anal and rectal areas [2]. The elements of the rash are flesh-colored, can be represented by smooth papules the size of a pinhead, and in the initial stages of development are not always noticeable on the penis. To identify them, a test is carried out with 5% acetic acid. After treatment of the skin, the color of the papules becomes whitish. Subsequently, the papules grow and take on a warty or thread-like shape, resembling cauliflower or cockscomb. As a rule, genital warts are multiple and located in groups.

In women, the clinical picture of genital warts can be varied. Classic exophytic lesions on the external genitalia are common and easily detected during examination, but they can also be accidental findings during colposcopy or sigmoidoscopy. On the labia minora and on the vestibule of the vagina, condylomas are moist, velvety or multiple finger-like growths and occupy a significant area. Condylomas in the cervical canal are found in 20% of women infected with HPV and with genital warts localized on the external genitalia. Localization of genital warts on the cervix or in the cervical canal is considered an unfavorable factor, as it can contribute to the development of cervical cancer [3].

Even with timely and rational treatment, genital warts often recur. This is due to the fact that the virus can remain in an inactivated state for a long time in apparently healthy areas of the skin and mucous membranes.

Differential diagnosis of genital warts is carried out with secondary syphilis (condylomas lata), molluscum contagiosum, bowenoid papulosis, lichen planus, lichen planus, angiokeratomas, angiofibromas on the coronal sulcus of the glans penis, folliculitis, soft fibroma, pilar cyst (Table 2).

Diagnosis of genital warts is usually not clinically difficult. Additionally, in some cases, a test is carried out with 5% acetic acid. To do this, a medical napkin moistened with a solution is placed in the area of ​​​​the expected localization of genital warts for 5–10 minutes, after which the rash acquires a whitish tint [4].

When diagnosing genital warts, it is necessary to conduct testing for syphilis and HIV infection.

A biopsy is indicated for those patients who suspect precancerous lesions or squamous cell carcinoma. Removing genital warts does not reduce the risk of developing cervical cancer. Therefore, all women who have a history of genital warts should undergo an annual cytological examination of cervical smears in order to timely detect the oncological process.

Treatment and prevention

Using condoms reduces the risk of infecting sexual partners. It is impossible to completely remove HPV; you can only remove genital warts, easing the patient’s condition and reducing the risk of infecting a sexual partner. There are several treatment methods for genital warts. They all have certain disadvantages.

Cryodestruction is one of the most commonly used treatment methods. The affected surface is treated with liquid nitrogen using a cotton swab or spray. The treatment is repeated every 1–2 weeks until all condylomas are completely removed. The method rarely leads to scarring and is low cost. Cryodestruction can cause severe pain. It is not always possible to treat the entire affected surface at once. In some cases, hyperpigmentation or hypopigmentation may develop after cryodestruction.

Diathermocoagulation is a painful method of treatment and leaves behind permanent scars, therefore it is used only for the removal of single condylomas.

Laser removal is carried out using carbon dioxide and neodymium YAG lasers (yttrium aluminum garnet lasers). Scars may remain after removal.

Drug treatment methods. Condilin (podophyllotoxin) - 0.5% solution in 3.5 ml bottles with an applicator. The component of Condilin, podophyllotoxin, is the most active in the composition of the plant extract of podophyllin; when applied topically, it leads to necrosis and destruction of genital warts. The advantage of this treatment method is that the patient can independently treat the affected areas of the skin in accessible areas. Using a plastic applicator, the drug is applied to the condyloma; All condylomas are gradually wetted, but no more than 50 pieces at a time (in area no more than 10 cm2). The drug should be applied with caution, avoiding healthy areas of the skin. The first time the treatment is carried out by a doctor or nurse, teaching the patient how to apply the drug correctly. After treatment, the preparation must dry to avoid irritation of the surrounding skin or ulceration. Condilin is applied 2 times a day for 3 days, and then take a 4-day break. The duration of treatment should not exceed 5 weeks. Contraindications for the use of the drug are pregnancy, lactation, childhood, and the use of other drugs containing podophyllin.

Solcoderm is a mixture of acids: 65% nitric, 98% acetic, as well as lactic and oxalic acid and copper nitrate; Available in the form of a solution (ampoules of 0.2 ml). After it is applied to the surface of the skin, it turns yellow, after which mummification of the treated tissue occurs. Treatment must be carried out by medical personnel. The drug is applied to the surface using a glass capillary or applicator, after which the drug must dry. It is allowed to treat an area of ​​no more than 4–5 cm2 at a time. If necessary, treatment can be repeated after 4 weeks. Application of the drug may be accompanied by severe burning and pain, in some cases hyperpigmentation and scarring may occur.

Interferon preparations are injected directly into genital warts. The procedure is painful and requires repeated treatment.

Trichloroacetic acid in a concentration of 80–90% is applied directly to the condylomas. Its remains are removed with talc or sodium bicarbonate. If necessary, treatment is repeated at intervals of 1 week. If after 6-fold treatment genital warts remain, then it is necessary to change the treatment method.

Literature

1. KR Beutner, TM Becker, KM Stone. Epidemiology of HPV infections // J. Am. Acad. Dermatol. 1988; 18: 169–172.
2. S. M. Syrjanen et al. Anal condylomas in men // Genitour. Med. 65: 1989; 216–224.
3. MJ Campion. Clinical manifestations and natural history of genital human papillomavirus infection // Obstet. Gynecol. Clin. North. Am. 1987; 14: 363–388.
4. D. E. Fitzpatrick, D. L. Eling. Secrets of dermatology // M.: ZAO Publishing House BINOM, 1999. 511 p.

L. P. Kotrekhova, Candidate of Medical Sciences, Associate Professor K. I. Raznatovsky, Doctor of Medical Sciences, Professor of St. Petersburg Medical Academy of Postgraduate Education, Moscow

Dermatillomania and anxiety

The American Psychiatric Association considers dermatillomania within the framework of obsessive-compulsive disorder (OCD). The term “neurotic excoriation” is used, that is, uncontrolled scratching.

The consciousness of a person with OCD is guided by a closed chain “restless thought - anxious expectation - fear - habitual ritual - relief”:

1. The thought of imperfection fuels a chronic anxiety background, in which it is unbearable to constantly exist.
2. A person again and again resorts to a familiar ritual, because he sees this as the only way to at least temporarily get rid of painful anxiety.
3. And the usual ritual here is bodily obsession: only after exposure to the skin does the stage of temporary relief and internal satisfaction begin.
4. Then discomfort inevitably increases again, dissatisfaction with the condition of the skin arises - the chain closes and everything happens again.

Manipulations lead to the desired relaxation, but not for long: anxiety subsides only for a while, and feelings of guilt and shame for one’s own “weakness” and loss of control are overwhelming.

“When you pick, you forget. Afterwards the relief will not last long. And when you look at the spotty face afterwards, you ask, “Why again?” After all, you could just not pick,” and it became sad to look at yourself in the mirror” (Ilona, ​​24 years old).

The girl says that she often gets hung up on negative thoughts:

“Usually this happens if I’m driven for some reason. Or after a quarrel with someone, I may feel somewhat inferior. On nerves, so to speak."

Ulyana Kardashevskaya (18 years old) also associates dermatillomania with increased anxiety:

“For me, this usually happens after a difficult day or, conversely, before some important event. You walk up to the mirror, think you’ll just look, and don’t notice how your fingers have already noticed an unevenness on the skin. I think a difficult relationship with my mother, my low self-esteem and high anxiety played a role here.”

Causes

Skin manipulation often helps a person suppress their own negative emotions. It's about anger, rage, disappointment. Complexes such as guilt, shame, and self-abasement can lead to the development of the disease. Other causes of dermatillomania:

• anxiety disorder;
• clinical depression.

In this case, the disease is one of the symptoms of mental disorders. Perceptible intense and acute stress conditions that last for a long time can also provoke the development of a disorder when a person constantly scratches the skin.

Nervous disorders alone cannot cause dermatillomania. Most often it begins after skin diseases or accompanies cosmetic problems.

A person sees a skin defect in the mirror and assumes that a pimple or acne may indicate the onset of serious diseases, so he begins to scratch the skin, since rashes and inflammations make him nervous and irritated. The degrees of the disease vary. Someone begins to uncontrollably squeeze out acne, and someone scratches a small injury, for example, an insect bite, on the scalp, believing that the consequences are invisible to others.

Dermatillomania as a way to survive violence

Nastya Simbirskaya also writes a blog about dermatillomania, in which she openly talks about the disorder. Its first manifestations occurred at the age of 6 years. According to the girl, in 20 years of living with dermatillomania, there was not a day when she did not touch her skin.

“This happened after my stepfather beat me for the first time. From that moment on, the punishments were regular; I could only distract myself by picking at my skin. And I began to understand that this was already a disease almost 20 years later. I thought I was the only one who was crazy.”

Psychoanalysts talk most about the relationship between skin diseases and traumatic memories from childhood.

According to their observations, the psyche of an adult is capable of regressing - returning to early childhood in order to act out the trauma that occurred not through the child’s fault, but which is still preserved in his unconscious.

And the younger the child, the more physical or emotional abuse will be imprinted on him. The psyche will not record actual memories, but bodily sensations and marks on the skin will remain for life.

“Since for me it is associated with domestic violence and with all the accompanying feelings during the 12 years that I was beaten, now I feel dermatillomania as a way to get rid of obsessive thoughts, emotional swings, fears, stress and suffering. The brain knows no other way to deal with these problems. It’s more convenient for him to cause himself physical pain than to experience psychological pain,” Nastya shares.

Who treats trichotillomania?

Regardless of the patient’s age, a psychiatrist must be involved in treatment. Of course, specialists of the relevant specialization work with children.

We know how to treat trichotillomania because we have been doing this for more than 10 years and we can confidently say: providing assistance and significant relief to people’s condition is possible!

Trichotillomania? We are ready to help you! Call us

Dermatillomania and the need to hurt oneself

Because dermatillomania affects the skin, the disorder is often associated with self-harm and the desire to intentionally hurt oneself. But in fact, the mechanisms of these two conditions are different.

Unlike self-harm, when a person intentionally causes physical pain to himself (for example, to cope with unbearable mental pain), dermatillomania cannot be controlled by the notorious “willpower.”

A person can cause harm to his own skin in a dream or, in the process, plunge into a kind of hypnotic trance and only then see with horror the result of his actions.

Elina Plance (20 years old) began to resort to self-harm after severe stress and quarrels in the family:

“I didn’t think about what was happening then. Now I understand that it was a cry for help due to broken communication with my parents. Alas, an unheard cry. This process distracted from feelings. I switched my attention from internal pain to external pain. This made me feel better. And from the feeling of punishment too.”

According to her, this happens consciously:

“It seems to me that I can even control it, but I don’t want to. In case of a breakdown, I emotionally go wildly destructive and do not want to save myself or feel sorry for myself. Well, emotion is followed by auto-aggressive behavior.”

Why am I doing this?

Many people understand that by not allowing their wounds to heal, they are only aggravating the situation, but obsession takes over.

Often this behavior is dictated by the desire to make oneself better, to remove imperfections, as if to get rid of an annoying problem.

But systematically picking the skin gives only imaginary relaxation: in fact, a person is worried about another, “invisible to the eye” problem, but since it cannot be solved here and now, the person changes the focus of attention to what he (she) is able to eliminate. Namely, visual imperfections of the skin.

“I do this when I’m not paying attention, when I’m bored, when I’m anxious, when I’m just irritated by uneven skin. I realize that the latter is my fault. But everything else is unconscious impulses,”

- writes Alaura.

Sometimes the cause of dermatillomania can be a person’s personal characteristics: pathologically altered character traits that interfere with a peaceful life (perfectionism, suspiciousness), or disorders (hysterical, anxious, borderline). Dermatillomania as a symptom of neurosis can be expressed in the need to constantly use your hands, calm your nerves, and be distracted by such a ritual.

Although dermatillomania can be a cause and consequence of body dysmorphic disorder (when a person is overly concerned about a defect or feature of his body), this obsession cannot be called self-harm. Injuries are a result, not a goal.

A person suffering from dermatillomania does not want to harm themselves, and sometimes the damage is unconscious , such as when a person scratches their skin in their sleep. Self-harm is an attempt to consciously hurt yourself, to drown out mental pain with physical pain.

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Dermatillomania and fear of judgment

An important diagnostic criterion for dermatillomania is preoccupation with causing damage. A person experiences a mixture of negative feelings towards himself (pity, shame, disgust, disappointment) due to the fact that he has lost control. Promises that this was the last time, that this will not happen again, are often not fulfilled - and the person is ashamed of his weakness, considers himself weak-willed.

As Nastya talks about it:

“Yes, at first the process is satisfying. But as soon as your consciousness returns and you see the result of your actions, a feeling of self-loathing, pity, powerlessness, apathy not only towards yourself, but also towards everything around you arises, aggression.”

Traces of dermatillomania - wounds and scars - provoke avoidance behavior and increase feelings of shame. A person in this state may withdraw, avoid public places, and experience difficulties in his personal life, work and friendships.

“With my brain, I understand that these [inflammations and traces of them] are trifles and people don’t care at all. They saw and forgot. But my sense of comfort does not allow me to take this calmly. I feel complex, I can’t leave the house without makeup,” Nastya shares.

“I know that they DO NOT CARE about my skin, but I still get stressed and feel awkward if a stranger is close and can easily see all my “imperfections,” says Ira Polevaya.

Dermatillomania and stigma

People with dermatillomania tend to deny the disorder to the last minute and attribute bodily obsession to a bad habit.

Advertising with photoshopped skin, taboo topics in the media, presenting information in such a way that it appears as if the person himself and his insufficient efforts to care for himself are to blame for imperfect skin - all this only pushes people to compulsively seek out and eradicate their “shortcomings.”

Elina Planze:

“Standards are a very narrow framework that not everyone fits into. Hence a lot of complexes, dislike and self-hatred. If a person is prone to this kind of behavior, all of the above can seriously undermine him. And in order to find relief, a person may resort to self-harm.”

Having imperfect skin is supposedly “unacceptable” from the point of view of beauty standards. Difference and dissimilarity from the person on the cover/screen/banner are unconsciously perceived as rejection in the social environment. You are different = you are a stranger. This can cause a lot of anxiety.

“I believe that the media should show different faces and bodies more often so that people do not strive for a non-existent ideal. When you see photoshopped skin, it seems that if you squeeze out a pimple, you will get the same one, but in reality you get a scar,” says Ulyana Kardashevskaya.

Dermatillomania is stigmatized, and it is shame that causes a person to remain silent and not seek help. It is difficult to explain to others (and most importantly, to oneself) why it is so difficult to control the obsessive desire to harm oneself.

Keeping the problem under wraps creates the perception that the disorder is rare. But, according to research, about 5% of people feel the need to harm their skin in one way or another, and this is one in twenty. It has been found that 3/4 of those who experience dermatillomania are women.

A loved one of mine has dermatillomania. What should I do?

Dermatillomania is destructive impulses, cravings that are difficult to resist. It is important to understand this and not shame a person with dermatillomania for their habit. Shame accompanies your loved one throughout their life. Delicacy and good manners in this matter are the main thing that will help in communication.

“Just stop doing this,” “Pull yourself together,” “Stop being weak (weak)” are not phrases that will help your loved one heal. “To everyone who is telling me to stop, I want to respond: I know what you mean, but believe me, this problem will not go away if you just tell me to stop. I appreciate your intentions, but I feel like I failed again,” says Alaura. Instead, the girl asks for something to occupy her hands (if the desire to damage the skin cannot be controlled even in a public place).

“How can I help you?”, “Let’s think together why you want to harm yourself?”, “What can be done instead?” - these questions, spoken in a calm, friendly tone, will relieve tension and distract a person with dermatillomania.

It is important for people with dermatillomania to know the following:

1. it is surmountable;
2. Having a disorder is not a shame, but you need to seek help;
3. silence only stigmatizes the disorder;
4. you are not alone, there are many of us.

The disorder itself or its result (scars, poorly healing wounds, lesions on the skin) does not make you worse. You can help yourself if you ask for help. You can improve your life.

How to help yourself with dermatillomania?

Dermatillomania is a reflection of internal problems, suppressed anxiety, aggression and a range of other emotions. It is pointless to treat only visible manifestations (damage or scars) if the behavior remains unchanged and the person will resort to the same way of responding every time.

It can be difficult to notice obsessive behavior, especially when it brings illusory comfort and is perceived as the only chance to cope with difficult emotions. But recognizing the disorder is the first and important step.

“I first learned about dermatillomania from the book “The Skin We Live In.” I was very surprised that this was a disease, and not just a bad habit,” recalls Inna (25 years old).

“Overcoming” the disorder in the usual sense will not work—the symptom cannot simply be removed from your head, like an annoying app on your iPhone. But it is quite possible to work with the disorder and find out what is hidden behind self-harmful behavior.

Some psychotherapeutic techniques have proven their effectiveness in the treatment of dermatillomania, for example, the dialectical behavioral approach or the habit reversal therapy method, borrowed from cognitive behavioral therapy.

How would people with dermatillomania want to be treated?

Environmental support is an important factor in dealing with any disorder. Dermatillomania has always been a taboo topic: it is not so easy in the era of eternal improvement and striving for the ideal to admit one’s imperfection.

“I would like at least someone to care what happens to me. So that close people who would notice that I have problems would try to find a solution with me (for example, support me in finding a psychotherapist). At the same time, I can’t blame those who think it’s just a bad habit. I myself once thought so, because little attention is paid to this disorder,” shares Inna.