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Cited by 172Obsessive-Compulsive Spectrum DisordersDermatology and Skin DiseasesBody Image and Dysmorphia Studies

N-Acetylcysteine in the Treatment of Excoriation Disorder: A Randomized Clinical Trial

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Grant, Jon E., Chamberlain, Samuel R., Redden, Sarah A., Leppink, Eric W., Odlaug, Brian L., Kim, Suck Won·2016·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2016.0060
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Abstract

IMPORTANCE: Excoriation (skin-picking) disorder (SPD) is a disabling, underrecognized condition in which individuals repeatedly pick at their skin, leading to noticeable tissue damage. To date, there has been no clearly effective pharmacologic or psychological treatment for SPD. OBJECTIVE: To determine whether N-acetylcysteine, an amino acid that appears to restore extracellular glutamate concentration in the nucleus accumbens, will be more effective than placebo in reducing compulsive picking behavior. DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind trial was conducted at ambulatory care centers at the University of Minnesota (September 12, 2011, to June 15, 2012) and the University of Chicago (December 17, 2012, to June 26, 2015) and included 66 adults with SPD. Data analysis was performed from July 16 to September 9, 2015. INTERVENTIONS: N-acetylcysteine (dosing range, 1200-3000 mg/d) or placebo was administered for 12 weeks. MAIN OUTCOMES AND MEASURES: Participants were assessed using measures of skin-picking severity, including the modified Yale-Brown Obsessive Compulsive Scale (NE-YBOCS); total scores range from 0 to 40, with higher scores reflective of greater symptom severity. Another measure of skin-picking severity was the Clinical Global Impression-Severity Scale; total scores range from 1 (normal) to 7 (among the most extremely ill patients), and improvement ratings range from 7 (very much worse) to 1 (very much improved). Selected cognitive tasks included the Intra-dimensional/Extra-dimensional Shift Task to examine cognitive flexibility, with the key outcome measures being the number of errors, and Stop-Signal Reaction Time task, which evaluates motor inhibition. Outcomes were examined using a linear mixed-effects model. RESULTS: Of the 66 participants (31 randomized to placebo and 35 to N-acetylcysteine) included in the analysis, 59 (89%) were women; mean (SD) age was 34.8 (11.0) years. Compared with placebo, N-acetylcysteine treatment was associated with significant improvements in the NE-YBOCS. At baseline, NE-YBOCS scores were 18.9 and 17.9 for the treatment and placebo groups, respectively, and at 12 weeks, the scores were 11.5 and 14.1 for the treatment and placebo groups, respectively (P = .048). For the Clinical Global Impression-Severity scale, baseline scores were 3.5 and 4.0 and 12-week scores were 3.0 and 4.2, respectively (P = .003). These effects were significant both in terms of treatment by time interactions and post hoc tests at 1 or more individual time points. At the study's end point, of the 53 participants who completed the study, 15 of the 32 participants (47%) receiving N-acetylcysteine were much or very much improved compared with 4 of the 21 participants (19%) receiving placebo (P = .03). There were no significant differences between the active and placebo arms in terms of psychosocial functioning. CONCLUSIONS AND RELEVANCE: N-acetylcysteine treatment resulted in significant reductions in skin-picking symptoms and was well tolerated. The glutamate system may prove a beneficial target in treating SPD and other compulsive behaviors. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01063348.

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  • N-acetyl cysteine has shown evidence of efficacy in double-blind placebo-controlled studies for trichotillomania and skin-picking disorder.

    “The glutamate modulator n‐acetyl cysteine has shown evidence of efficacy, in double‐blind placebo‐controlled studies, for OC‐related disorders trichotillomania and skin‐picking disorder”

    From Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction (2023) · cites this paper as Grant et al., 2016

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  1. First MB, Spitzer RL, Gibbon M. Structured Clinical Interview for DSM-IV-Patient Edition (SCID-I/P, Version 2.0). New York: Biometrics Research Dept, New York State Psychiatric Institute; 1995.

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Authors
Grant, J. E., Chamberlain, S. R., Redden, S. A., Leppink, E. W., Odlaug, B. L., & Kim, S. W.
Affiliations
  • University of Chicago (US)
  • University of Cambridge (GB)
  • University of Copenhagen (DK)
  • University of Minnesota (US)
Corresponding author
Grant, Jon E.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2016-05-01
Volume
73
Issue
5
Pages
490
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2016.0060
OpenAlex
W2305927117
Cited by
172
References
46
Citations by year
2026: 15 · 2025: 19 · 2024: 15 · 2023: 15 · 2022: 14 · 2021: 24 · 2020: 17 · 2019: 18 · 2018: 20 · 2017: 9 · 2016: 5 · 2015: 1
FWCI
23.20
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
  • Apollo (University of Cambridge) (submittedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
  • Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
Keywords
excoriation disorder, skin picking disorder, glutamate, nucleus accumbens, obsessive-compulsive symptoms, cognitive flexibility, motor inhibition, pharmacotherapy, Yale-Brown Obsessive Compulsive Scale, Clinical Global Impression Scale, stop-signal reaction time
MeSH terms
Acetylcysteine, Adolescent, Adult, Aged, Dose-Response Relationship, Drug, Double-Blind Method, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Nucleus Accumbens, Obsessive-Compulsive Disorder, Skin, Self-Injurious Behavior, Glutamic Acid, Young Adult

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