Successful Treatment of Facial Neurotic Excoriations with Onabotulinumtoxina and Updated Review of Cosmetic and Non-Cosmetic Uses

Neurotic excoriations are repetitive self-inflicted lesions caused by skin picking and scratching that occurs in the absence of a known physical pathology. They are usually associated with a psychological or medical condition that causes dysesthesia or psychological distress. This case describes a 36-year old man with neurotic excoriations associated with tension headaches, who had failed a trial of behavioral coaching and antidepressant medication. He was treated with onabotulinumtoxinA (BoNT) injections to the glabella and forehead, which caused resolution of his headaches and eliminated his excoriating behaviors. He has remained in remission with a combination of antidepressants and maintenance injections of BoNT. This is the first case to our knowledge to report successful treatment of facial neurotic excoriations with BoNT injections, which highlights one of many non-cosmetic uses for BoNT. Along with non-cosmetic utility, many reports of successful “off-label” (non-Food and Drug Administration (FDA) approved) treatments with BoNT exist in the medical literature, which were compiled for this brief review.