Excoriation
An excoriation is a break in the skin produced by scratching or rubbing rather than by the underlying condition itself. Clinicians distinguish it from primary changes because it records what has been done to the skin, not what is happening in it.
Skin carries two kinds of marks at once: those produced by whatever is happening in it, and those produced by the person living in it. An excoriation belongs to the second category.
The word describes a break in the surface made by scratching or rubbing. Clinicians separate these from primary changes deliberately, using the terms primary for what a condition produces directly and secondary for what follows, because reading the two as one thing obscures the condition underneath.
Their pattern is informative in its own right. Linear scratches indicate fingernails. Where they appear tells you where the itch is worst, which may not be where the visible changes are most dramatic. Their presence establishes that something itches enough to be scratched until the skin breaks, which is a measure of severity independent of how the rash looks.
Where they are absent, that is also worth noting, since it suggests either that the condition does not itch or that it is being resisted.
Broken skin admits more of whatever provoked the reaction in the first place, and the resulting inflammation produces more itch, which is the loop at the centre of eczema. Excoriations are both a consequence of that cycle and a contributor to it.
Nobody in a consultation is being judged for having scratched. Clinicians record excoriations because they are evidence, and expect to find them.
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