title: A near fatal case of pathological skin picking.
abstract: METHODS
  Female, 51 FINAL DIAGNOSIS: Patological skin picking Symptoms: Aphasia • headache • hemiparesis • incontinence
  
  
  METHODS
  - Clinical Procedure: - Specialty: Dermatology.
  
  
  OBJECTIVE
  Challenging differential diagnosis.
  
  
  BACKGROUND
  Pathological skin picking (PSP) disorder is characterized by repetitive and compulsive picking of the skin resulting in tissue damage. PSP has been shown to affect 5.4% of a community sample, 4% of college students, and 2% of patients seen in a dermatology clinic. It can be associated with significant disfigurement. The diagnosis requires obtaining a careful history and high clinical suspicion.
  
  
  METHODS
  We report a previously healthy 51-year-old Caucasian female with a history of "acne" who presented with new onset right-sided hemiparesis, mild aphasia and an episode of incontinence. She had memory loss of the prior few days. She also complained of a four-day history of intense headaches and dizziness. CT and MRI of the head showed encephalomalacia involving the left frontal and parietal lobes. Further history from the patient revealed that the patient had been picking at her forehead with a sewing needle and later with a long knitting needle.
  
  
  CONCLUSIONS
  PSP is a prevalent disorder, which can have potentially serious health consequences. Besides potential disfigurement and scarring, PSP can have significant morbidity and mortality. Early diagnosis and appropriate treatment by clinicians are essential to prevent potentially fatal consequences.
authors.affiliation: Department of Medicine, Riverside County Regional Medical Center, Loma Linda University School of Medicine, Moreno Valley, CA, U.S.A.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Kim
authors.forename: Roger C
authors.initials: RC
authors.lastname: Garrison
authors.forename: Gary
authors.initials: G
authors.lastname: Thompson
keywords: impulse control disorde; pathologic skin picking
references.citation: Behav Modif. 2006 Jul;30(4):411-22
references.pmid: 16723422
references.citation: Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001765
references.pmid: 18253995
references.citation: J Clin Psychopharmacol. 2010 Aug;30(4):396-403
references.pmid: 20531220
references.citation: Psychosomatics. 2001 Jul-Aug;42(4):314-9
references.pmid: 11496020
references.citation: J Psychiatr Res. 2006 Sep;40(6):494-501
references.pmid: 16430922
references.citation: Gen Hosp Psychiatry. 2006 Nov-Dec;28(6):487-93
references.pmid: 17088164
references.citation: Eur Arch Psychiatry Clin Neurosci. 2006 Dec;256(8):464-75
references.pmid: 16960655
references.citation: Curr Psychiatry Rep. 2009 Aug;11(4):283-8
references.pmid: 19635236
references.citation: Int Clin Psychopharmacol. 2007 Sep;22(5):268-74
references.pmid: 17690595
references.citation: Behav Res Ther. 2011 Jan;49(1):11-7
references.pmid: 20934685
references.citation: Depress Anxiety. 2010 Jun;27(6):611-26
references.pmid: 20533371
references.citation: Psychiatry (Edgmont). 2009 Feb;6(2):38-42
references.pmid: 19724747
references.citation: J Clin Psychiatry. 1997 Aug;58(8):341-7
references.pmid: 9515971