Management of Neurotic Excoriations

First-Line Treatment Approach

Cognitive Behavioral Therapy (CBT) should be the first-line treatment for patients with neurotic excoriations related to depression or anxiety, as recommended by the American College of Psychiatry 1, 2
CBT has demonstrated high-quality evidence for treating both depression and anxiety, which are common underlying factors in neurotic excoriations, with a strong association between neurotic excoriations and psychiatric comorbidities 2, 3

For patients with moderate to severe depressive symptoms, selective serotonin reuptake inhibitors (SSRIs) should be considered, as they have shown efficacy in treating depression and anxiety, according to the National Institute of Mental Health 4
If both anxiety and depression are present, treatment of depressive symptoms should be prioritized, or a unified treatment protocol combining approaches for both conditions should be used, as suggested by the American Psychiatric Association 1, 3
For patients with insufficient response to SSRIs, serotonin-norepinephrine reuptake inhibitors (SNRIs) may be considered, as they have shown some efficacy in case reports, according to the Journal of Clinical Psychopharmacology 5

Initial assessment should include evaluation of severity of neurotic excoriations and underlying psychiatric symptoms, as well as screening for depression and anxiety using standardized tools, as recommended by the American Academy of Dermatology 1, 2, 6
Regular assessment of treatment response is essential, with evaluations at baseline, 4 weeks, and 8 weeks, to monitor symptom relief, side effects, and satisfaction, according to the National Institute of Mental Health 2, 3

Regular assessment of treatment response using standardized validated instruments is crucial, with assessments at pretreatment, 4 weeks, 8 weeks, and end of treatment, as recommended by the American Psychological Association 1, 3
If symptoms are stable or worsening after 8 weeks of treatment, re-evaluate and revise the treatment plan, as suggested by the American College of Psychiatry 1, 3