Transcranial magnetic stimulation treatment for dermotillomania: a multidisciplinary approach focused on circuitries and neuroplasticity

Dermotillomania in the Manual for Mental Disorders (DSM5- TR) is included in the chapter "Obsessive-Compulsive Disorders and Related Disorders". Dermotillomania is a disorder characterised by the compulsive damaging of skin tissue through repetitive behaviour. For this reason, patients suffering from this disabling condition are often referred to dermatologists claiming therapy or cosmetic remedies. Repetitive Transcranial Magnetic Stimulation has been approved for the treatment of Obsessive-Compulsive disorder. It has been recently reported to be a promising therapy in other compulsive spectrum disorders, such as trichotillomania and skin picking. According to the "Research Domain Criteria", a circuit-oriented approach targeting the dorsolateral prefrontal cortex to modulate reward and compulsivity circuitries and implied in dermotillomania. A recent report for Obsessive-Compulsive disorder Spectrum Disorders highlights the deleterious effect of inflammation on brain plasticity that affects neuroplasticity and the specific treatment. Given this, some laboratory testing for inflammation has been included in our assessment to reduce the contrast to the therapeutic mechanisms underlying neuroplasticity induced by the Repetitive Transcranial Magnetic Stimulation treatment; this is the first case reporting Repetitive Transcranial Magnetic Stimulation as effective in reducing the dermotillomania to remission. Further studies are needed to validate this proof-of-concept case and this multidisciplinary approach for these disorders, which are not so rare, targeting a brain area highly implicated in the Reward Circuitries.