Editorial

Darkness Visible: Psychocutaneous Disease

Authors: David J. Elpern, MD

Abstract

A dejected, overweight young woman with excoriations on her face and arms sits in my examination room. Her intake form says “pimples and itching.” Every few months I see similar patients, almost all women. They've been to their primary care providers, seen therapists, and often consulted other dermatologists. It is unclear what they were told and I'm not sure I can offer much help. This woman and her doppelgangers are excoriators and some darkness in their early or present lives has usually set the stage for this type of self-destructive behavior. Compulsive picking is akin to other self-destructive behaviors (like cutting), and it is difficult to manage.

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