A near fatal case of pathological skin picking

PATIENT Female, 51 FINAL DIAGNOSIS: Patological skin picking Symptoms: Aphasia • headache • hemiparesis • incontinence MEDICATION - 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. CASE REPORT 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.