Find comprehensive information on Skin Picking Disorder (SPD), also known as Dermatillomania or Excoriation Disorder. This resource covers clinical documentation, DSM-5 criteria, ICD-10 code L98.1 for Excoriation (skin picking), medical coding guidelines, and best practices for healthcare professionals. Learn about diagnosis, treatment options, and support resources for patients with compulsive skin picking.
Also known as
Dermatitis artefacta
Self-inflicted skin lesions due to scratching or picking.
Other impulse control disorders
Covers impulse control issues not elsewhere classified, sometimes including skin picking.
Obsessive-compulsive disorder
May be relevant if skin picking is part of OCD rituals.
Problems related to lifestyle
Can be used for counseling related to habits like skin picking.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is skin picking behavior present?
Yes
Clinically significant distress or impairment?
No
Do not code skin picking.
When to use each related code
| Description |
|---|
| Recurrent skin picking resulting in lesions. |
| Body-focused repetitive behavior other than hair pulling or skin picking. |
| Obsessive-compulsive and related disorder NOS. |
Coding L98.1 lacks severity specificity (mild, moderate, severe) impacting reimbursement and quality reporting. CDI crucial for clarification.
Confusing excoriation (L98.8) as the primary diagnosis instead of L98.1 if picking is the cause. Accurate documentation is key.
Failing to code co-occurring mental health conditions like OCD or anxiety alongside L98.1, impacting treatment plans and resource allocation.
Q: What are the most effective evidence-based treatment approaches for adults with chronic Skin Picking Disorder (Excoriation Disorder) resistant to first-line interventions?
A: For adults with chronic Skin Picking Disorder (Excoriation Disorder) resistant to first-line interventions like Habit Reversal Training (HRT), consider implementing a multi-pronged approach. Evidence suggests that combining HRT with Acceptance and Commitment Therapy (ACT) can improve treatment outcomes. Additionally, explore how pharmacotherapy, specifically selective serotonin reuptake inhibitors (SSRIs) or N-acetylcysteine (NAC), may be beneficial as an adjunct to behavioral therapies. It is crucial to conduct a thorough assessment of any co-occurring psychiatric conditions, such as anxiety or depression, as these can exacerbate skin picking. Addressing these comorbidities through appropriate interventions like Cognitive Behavioral Therapy (CBT) or medication can further enhance treatment efficacy. Learn more about integrating motivational interviewing techniques to address ambivalence towards treatment adherence.
Q: How can clinicians differentiate between Skin Picking Disorder (Excoriation Disorder), obsessive-compulsive disorder (OCD), and body-focused repetitive behavior (BFRB) like trichotillomania in a clinical setting?
A: Differentiating between Skin Picking Disorder (Excoriation Disorder), OCD, and other BFRBs like trichotillomania requires careful assessment. While these conditions share some overlapping features, key distinctions exist. In Skin Picking Disorder, the primary focus is on skin imperfections, leading to picking behavior. In contrast, OCD involves intrusive thoughts (obsessions) that trigger repetitive behaviors (compulsions) aimed at reducing anxiety. These compulsions are often unrelated to the skin. Similarly, trichotillomania involves hair pulling, not skin picking. Explore how the Skin Picking Impact Scale and the Milwaukee Inventory for Subtypes of Trichotillomania (MIST) can aid in differential diagnosis. Consider implementing a structured clinical interview that assesses the function of the behavior, the presence of premonitory urges, and the emotional consequences associated with each condition to arrive at an accurate diagnosis.
Patient presents with skin picking disorder, also known as dermatillomania, excoriation disorder, or neurotic excoriation. The patient reports recurrent skin picking resulting in skin lesions, clinically evident on examination. The patient acknowledges attempts to stop skin picking but describes difficulty controlling the behavior. The picking behavior causes significant distress and impairment in social, occupational, or other important areas of functioning. The skin picking is not attributable to the physiological effects of a substance (e.g., cocaine) or another medical condition (e.g., scabies). Symptoms are not better explained by another mental disorder such as trichotillomania, obsessive-compulsive disorder, body dysmorphic disorder, delusional infestation, or stereotypic movement disorder. Differential diagnosis considered and ruled out includes other body-focused repetitive behaviors, substance-induced skin lesions, and medical conditions causing pruritus. Assessment includes evaluation of the frequency, duration, and severity of skin picking, triggers, and associated thoughts and feelings. Treatment plan may include cognitive behavioral therapy (CBT), habit reversal training (HRT), acceptance and commitment therapy (ACT), andor pharmacotherapy such as selective serotonin reuptake inhibitors (SSRIs). Patient education provided on skin picking disorder, treatment options, and coping strategies. Follow-up scheduled to monitor progress and adjust treatment as needed. ICD-10 code L98.1, Excoriation (skin picking) disorder, is assigned.