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Self-induced facial excoriations and ocular trauma: a treatment dilemma
  1. Nicholas R Mahoney1,
  2. Richard L Anderson2,
  3. John D McCann2,
  4. Don O Kikkawa3,
  5. Stephen E Orlin4,
  6. M Reza Vagefi5
  1. 1Division of Cosmetic and Reconstructive Oculoplastic Surgery, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2Center for Facial Appearances, Salt Lake City, Utah, USA
  3. 3Department of Ophthalmology, Shiley Eye Center, University of California San Diego, La Jolla, California, USA
  4. 4Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, USA
  5. 5Department of Ophthalmology, University of California—San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Nicholas Mahoney, 600 N Wolfe Street, Maumenee 505, Baltimore, MD 21231, USA; nicholas.mahoney{at}

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Psychogenic excoriation is self-injurious behaviour characterised by compulsive picking of skin with negligible imperfections.1 Psychogenic parasitosis is an uncommon disorder in which patients have a false, fixed belief of being infested by an organism.2 Individuals may provide false evidence of infestation and frequently induce mechanical trauma to clear the purported organism.2

We present five unique cases of self-induced facial excoriations with psychiatric disease ranging from psychogenic excoriation to psychogenic parasitosis.

Patient 1 presented with a vertical hypertrophic scar involving the forehead (figure 1A). The patient admitted to skin picking. Three years earlier, an abscess from repeated acne pustule manipulation required surgical drainage. The scar was injected with triamcinolone acetonide with improvement.

Figure 1

(A) Case 1: central forehead scar at the hairline. …

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  • Competing interests None.

  • Patient consent Detail has been removed from these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval Ethics approval was provided by Washington. The study was approved by Western Institutional Review Board, Olympia, WA.

  • Provenance and peer review Not commissioned; internally peer reviewed.