Improvement of chronic neurotic excoriations with oral doxepin therapy

Two patients with 6- to 7-year histories of neurotic excoriations refractory to the usual dermatologic management were referred for evaluation. Both had symptoms and signs of depression associated with the onset and persistence of the skin condition. Doxepin, a tricyclic antidepressant therapy with potent antihistamine properties, was used in oral doses of 30-75 mg daily for our patients. This therapy resulted in symptomatic and clinical improvement in both patients within several weeks. This limited report of apparent benefit of doxepin in two patients with neurotic excoriations and depression offers a potential therapy in the management of this challenging clinical problem.