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Psychodermatology: An Opportunity for Collaboration Among Health Care Professionals
Article Author(s): Xiaofeng Yan, MD, PhD, & James A. Bourgeois, OD, MD
February 28, 2025, Psychiatric Times, Vol 42, Issue 2
Excerpt:
Case Vignette
“Helen,” a 51-year-old woman with a history of depressive disorder, fibromyalgia, and excoriation (skin-picking) disorder, presented to the pain clinic for fibromyalgia management. Notably, she reported that her repetitive skin-picking disorder emerged following an experience in an abusive intimate relationship.
Helen had never been treated for her excoriation disorder and was not on any psychotropic medications. Upon examination, she exhibited erythematous papules with accompanying excoriations and adjacent scarring on the anterior chest, upper back, bilateral arms, and legs. She was initiated on naltrexone 4.5 mg/day for fibromyalgia.
Three months later, Helen returned to the pain clinic for a follow-up. She reported that naltrexone had improved her excoriation disorder, and she felt a reduced urge to scratch her skin. On examination, the areas previously affected by erythema and excoriation were healing, and there were fewer new lesions.
A month following this visit, Helen was advised to discontinue naltrexone due to an upcoming outpatient procedure with another medical service. In the interim, her skin-picking disorder intensified. When her procedure was over, she resumed naltrexone. Upon her return to the pain clinic 2 months later, she reported a perceived improvement in her excoriation disorder and expressed a desire to continue naltrexone.