Pharmacotherapy

There are no labeled medications for the treatment of Excoriation Disorder and research into pharmacotherapeutic efficacy for Excoriation Disorder is relatively limited at this time.

Data regarding the efficacy of serotonin reuptake inhibitors has been mixed. Based on the research, fluoxetine (target dose of 60mg/day), citalopram (target dose of 20mg/day), and escitalo- pram (target dose of 25mg/day) may all be somewhat beneficial for Excoriation Disorder.

The opioid antagonist, naltrexone (50mg/day) has demonstrated some benefit for Excoriation Disorder, as has the glutama- tergic agent n-acetylcysteine (NAC) (1,800mg/day); however, these medications have been used in small samples of patients. Adult patients with Skin Picking Disorder should start treatment with n-acetylcysteine at 600mg twice/day for one week, then 1,200mg twice/day for up to four weeks, and then 1,800mg upon awakening and 1,200mg about 10 hours later per day.

initiation/ongoing Treatment

Baseline investigations are not needed before starting SSRIs or NAC. If someone responds to an SSRI or NAC, a course of treatment should be for at least one year. Similarly, if depression or anxiety is co-occurring, SSRI medication management for at least one year may be necessary. In cases where the patient presents with suicidal ideation or plan, appropriate clinical interventions should be made prior to treating the skin picking symptoms.

Baseline investigations prior to initiation of naltrexone should include liver function tests. These should be repeated at 3 and 6 months, then at 1 year, then annually thereafter (unless there are specific concerns).

Before starting psychotherapy, the clinician should make sure the patient (and family, in the case of children) knows the intended number of therapy sessions and the need to perform homework assignments.

 
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