Catastrophic medical complication in psychogenic excoriation

Compulsive skin picking generally has limited potential health consequences. We describe a case with severe neurologic sequelae and review the literature to assess factors that likely contributed to the failure to prevent this severe outcome. Despite efforts to integrate treatment, our patient had severe medical complications, an epidural abscess and subsequent paralysis, as a result of compulsive skin picking. Psychogenic excoriation should not be underestimated as a cause of medical complications or as a treatment challenge, particularly in light of the numerous complicating factors often present in such cases.