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Sir: Psychogenic excoriation, or pathologic skin picking, is a well-recognized syndrome characterized by excessive scratching or picking of normal skin or skin with minor irregularities.1 Case studies, open trials, and small double-blind studies report efficacy with selective serotonin reuptake inhibitors.1 We describe a female patient whose psychogenic excoriation was unresponsive to a serotonin-norepinephrine reuptake inhibitor, but improved markedly when aripiprazole was added.