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Alternative Therapies for Excoriation (Skin Picking) Disorder: A Brief Update.

Context • Excoriation (skin picking) disorder is characterized by the need or urge to pick, scratch, pinch, touch, rub, scrub, squeeze, bite, or dig the skin, and it can be a perplexing condition for the inexperienced physician. Treatments include pharmacotherapy, psychotherapy, and alternative therapies. Alternative therapies for excoriation disorder and other body-focused repetitive behaviors include yoga, aerobic exercise, acupuncture, biofeedback, hypnosis, and inositol and N-acetylcysteine, among others. Objective • This review article intended to review the current literature on the alternative therapies to provide a brief update on their benefits for the treatment of excoriation disorder for use in conjunction with psychotherapy and pharmacotherapy in the management of a challenging group of patients. Design • This review (focusing on literature published in the last 15 y, selected from a search of PubMed) critically considers the evidence for the use of alternative therapies in the treatment of excoriation disorder. Setting • This review was conducted at the National University of Asunción (San Lorenzo, Paraguay). Results • Results for yoga were as follows: This technique may influence the structure and functioning of the areas of emotional processing involved in the pathophysiology of excoriation disorder and other body-focused repetitive behaviors, such as trichotillomania. Although still limited, the current research team's use of yoga as a treatment has given useful results. Results for aerobic exercise were as follows: People suffering from excoriation disorder and other-body focused repetitive behaviors generally have a worsening of their behaviors in times of negative mood and anxiety. As exercise has qualities that allow individuals to improve their mood and reduce their anxiety, it is likely that it also can help reduce behaviors like hair pulling or scratching, and it should be considered to be an adjunctive therapy. Results for acupuncture were as follows: The mechanism of action of acupuncture increases serotonergic activity and releases endorphins in the hypothalamus and limbic region, which could be beneficial in patients with trichotillomania and excoriation disorder. Results for biofeedback were as follows: Several case reports have suggested the value of biofeedback in reducing tics, which bear some psychophysiological similarities to body-focused repetitive behaviors, such as trichotillomania and excoriation disorder. Results for hypnosis were as follows: When used as a channel for other types of interventions, such as psychotherapy, hypnosis can help counteract the stress that triggers the picking behaviors in some patients. Results for inositol and N-acetylcysteine were as follows: Although more research is needed, these are promising drugs that may be helpful in reducing the picking behavior. Conclusions • The review indicates that yoga, aerobic exercise, acupuncture, biofeedback, hypnosis, and inositol and N-acetylcysteine all show promise in the treatment of excoriation disorder and other body-focused repetitive behaviors, such as trichotillomania. In the current research team's experience, mainly yoga and aerobic exercise have been shown useful in combination with psychotherapy and pharmacotherapy. Obtaining solid evidence about the long-term beneficial effects of these alternative therapies for the treatment of excoriation disorder requires more investigation.

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