History:

Patients with neurotic excoriations differ from those with dermatitis artefacta in that they admit to picking and digging at their skin. This habit affects women more often than men and is maximum at times of stress. Clinically there is mixture of crusted excoriations, scars and hyperpigmentation involving  mainly the face, neck, shoulders and arms. The condition may last for years and treatment is rarely successful. The patient in the current case is 77 years old woman who developed the habit of excoriating and digging her skin 2 years before after she was exposed to great psychological stress and she was obliged to leave her house. The characteristic finding is the confinment of her bizarre lesions to one shoulder area (unilateral).