Beyond Cutaneous Injury: Psychopathological Mechanisms, Differential Diagnosis, and Interdisciplinary Management of Excoriation Disorder and Dermatitis Artefacta

Self-inflicted dermatoses, particularly excoriation disorder and dermatitis artefacta, represent complex clinical conditions involving interactions between psychopathological mechanisms, behavioral disturbances, and recurrent cutaneous injury. This narrative review aimed to analyze the psychological factors, dermatological characteristics, diagnostic challenges, and interdisciplinary therapeutic strategies associated with these disorders, integrating international scientific evidence with contributions from Latin America. Relevant publications addressing epidemiology, psychiatric comorbidities, clinical manifestations, differential diagnosis, and treatment outcomes were examined through a descriptive and comparative approach. Epidemiological findings identified a current prevalence of excoriation disorder of 2.1%, a lifetime prevalence of 3.1%, and a pooled prevalence of 3.45% across different investigations. Anxiety, emotional dysregulation, compulsivity, and difficulties in behavioral inhibition emerged as relevant factors associated with symptom persistence. Diagnostic analysis revealed important differences between excoriation disorder and dermatitis artefacta, particularly regarding behavioral awareness, psychological context, and lesion characteristics. Therapeutic evidence supported behavioral interventions, including habit reversal training and cognitive behavioral therapy, while pharmacological investigations demonstrated favorable but variable outcomes with N-acetylcysteine. Interdisciplinary management involving dermatology, psychiatry, and psychology was identified as a clinically relevant approach for addressing cutaneous complications, psychiatric comorbidities, and recurrent behaviors. Nevertheless, methodological heterogeneity, limited long-term follow-up, and insufficient regional representation restrict the generalizability of available findings. In conclusion, accurate diagnostic differentiation, individualized psychological intervention, and coordinated clinical management constitute fundamental components of comprehensive care for self-inflicted dermatoses. Further multicenter investigations are necessary to strengthen therapeutic evidence and improve accessibility to specialized psychodermatological services.