N-Acetylcysteine curbs compulsive skin picking in trial

By David Douglas

NEW YORK (Reuters Health) - N-acetylcysteine is significantly more effective than placebo in reducing symptoms of excoriation (skin-picking) disorder, according to new research.

As Dr. Jon E. Grant told Reuters Health by email, "The study represents a potentially effective treatment option for the millions of people who struggle with skin-picking disorder (SPD)."

In a March 23 online paper in JAMA Psychiatry, Dr. Grant, of the University of Chicago, and colleagues noted that although the estimated prevalence of SPD runs as high as 5.4%, the disease is poorly understood and there is no approved treatment.

They pointed out that glutamatergic dysfunction has been implicated in the pathophysiology of compulsive or habitual behaviors. N-acetylcysteine, an antioxidant and cysteine prodrug, increases extracellular levels of glutamate. The agent has shown some success against trichotillomania (hair pulling) and the researchers sought to find out whether this might be the case with SPD.

In a trial conducted at ambulatory care centers of the University of Minnesota and the University of Chicago in 2011-2012, the team randomized 66 patients with a mean age of 34.8 years to N-acetylcysteine (1,200 to 3,000 mg per day) or placebo for 12 weeks.

Of the 53 patients who completed the study, 47% of the active treatment group reported notable improvement in behavior, significantly more than the 19% who reported such improvement in the placebo group.

Yale-Brown Obsessive Compulsive Scale scores modified for Neurotic Excoriation (NE-YBOCS) fell from 18.9 at baseline in the active treatment group to 11.5 at the end of the study, on a scale of 0 to 40. This was significantly more than the drop from 17.9 to 14.1 seen in the placebo group.

The researchers noted no significant differences between groups in terms of psychosocial functioning. Thus, they suggest that the benefits achieved "appear to be primarily in the reduction of urges or cravings to pick (reflected by the NE-YBOCS subscale score) rather than the actual behavior."

While many questions remain, the agent "appears to be effective and well tolerated in the acute treatment of SPD," they said.

"In addition," Dr. Grant pointed out, "the treatment is available without prescription and therefore people who are too embarrassed about the behavior to ask a physician for help, may find relief on their own."

Great American Health provided the study drug. Three coauthors reported disclosures.

SOURCE: http://bit.ly/25ucOQO

JAMA Psychiatry 2016.

(c) Copyright Thomson Reuters 2016. Click For Restrictions - http://about.reuters.com/fulllegal.asp