Body-focused repetitive behaviors and the dermatology patient

Body-focused repetitive behaviors (BFRBs) are psychiatric disorders that involve recurrent pulling and picking one's own body resulting in skin lesions with varying degrees of severity. For that reason, the interface with dermatology is important. Currently, the classified BFRBs are trichotillomania and excoriation disorder. Both trichotillomania and excoriation disorder appear to be more common than previously thought. Besides that, most patients are unlikely to seek mental health treatment for their condition. Thus, many patients will instead seek dermatologic help due to the cosmetic damage incurred. In trichotillomania, the main characteristic is the pulling out of one's hair, most commonly from the scalp. It is associated with many negative consequences. Patients may present with different patterns of alopecia. Often, more than one body part will be affected. In excoriation disorder, the pathologic behavior frequently starts with picking at an underlying dermatologic condition such as acne but can continue after dermatologic treatment. The body area most frequently picked is the face, but other sites may also be involved. The dermatologic findings and distribution are atypical and will help the clinician differentiate from other dermatologic conditions. A complete therapeutic plan for BFRBs should include a dermatologic assessment of the affected areas, psychotherapy, and possibly pharmacotherapy.