Kim Daniel I, Garrison Roger C, Thompson Gary
Department of Medicine, Riverside County Regional Medical Center, Loma Linda University School of Medicine, Moreno Valley, CA, U.S.A.
Am J Case Rep. 2013 Jul 29;14:284-7. doi: 10.12659/AJCR.889357. Print 2013.
Female, 51 FINAL DIAGNOSIS: Patological skin picking Symptoms: Aphasia • headache • hemiparesis • incontinence
Challenging differential diagnosis.
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.
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.
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.
女性，51岁
病理性皮肤搔抓症
失语、头痛、偏瘫、失禁
皮肤科
具有挑战性的鉴别诊断
病理性皮肤搔抓症（PSP）的特征是反复强迫性搔抓皮肤导致组织损伤。PSP在社区样本中的发病率为5.4%，在大学生中为4%，在皮肤科门诊患者中为2%。它可能导致严重的容貌损毁。诊断需要详细的病史询问和高度的临床怀疑。
我们报告一例既往健康的51岁白种女性，有“痤疮”病史，出现新发右侧偏瘫、轻度失语和一次失禁发作。她对之前几天的事情有记忆丧失。她还主诉有四天的剧烈头痛和头晕病史。头部CT和MRI显示左侧额叶和顶叶脑软化。进一步询问患者病史发现，患者先用缝衣针，后用长织针搔抓前额。
PSP是一种常见疾病，可能产生潜在的严重健康后果。除了可能导致容貌损毁和瘢痕形成外，PSP还可能导致严重的发病和死亡。临床医生早期诊断并给予适当治疗对于预防潜在的致命后果至关重要。
