Skin Picking Disorder (aka. Excoriation Disorder)
Sally is a thirty something who just can't stop picking her skin. It usually starts off with some small blemish or imperfection. Unfortunately, Sally has a hard time affecting that things can't be perfect... And so the picking starts... Even when there is bleeding and scabs, she can't stop resist her urges. Summers are stressful in particular, because she worries about others seeing the scabs and scars on her arms and legs. She'd like to get help with it, but she's been so embarassed about it that its hard to talk to anyone about it...
It is common for many people to pick at their skin from time to time. For example, people may pick at their acne, moles, freckles, sores, and scabs. They may even pick at things in their skin where others wouldn't see anything wrong. When the picking becomes so serious that it causes problems in one’s life, it may be skin picking disorder.
Other terms used include dermatillomania, excoriation disorder, compulsive skin picking.
- Does picking at your skin take up a lot of time during the day?
- Do you have noticeable scars from skin picking?
- Do you feel upset when you think about how much you pick your skin?
- Does picking at your skin get in the way of your social or professional life? For example, do you avoid the beach or the gym because people might see your scars? Or do you spend a lot of time covering up sores before work or social events?
It is estimated that as many as 5% of the population (i.e. 1 in 20 people) have it.
It usually starts around age 15-45, and mainly affects females.
The exact causes are not currently known. However, it is believed to be associated with the following common triggers and contributing factors include:
- People often report that the skin picking started after a infection or injury to their skin, and after that they had a scab that they started to pick at…
- Stress, such as with relationships, home, school and/or work.
- The behaviour often starts after a minor skin lesion or blemish; but can also start even with healthy skin;
- An irresistible urge to pick, scratch, dig or scrape the skin that damages the skin;
- The person may use instruments such as tweezers, pins, scissors or knives;
- A feeling of temporary relief from emotional distress after the skin picking occurs;
- Considerable time spent picking, often several hours per day, and worse in the evenings;
- The behaviour may occur when you aren’t even consciously aware of it;
- There may be attempts to resist or stop the behaviour;
- The person may reluctant to show the areas of damaged skin;
- Symptoms get in the way of life such as relationships, work or school.
It is important to see a doctor, as there are medical conditions that can lead to skin picking, such as various types of skin disorders (such as psoriasis and scabies), and other medical conditions that can lead to itchy skin (e.g. low iron and liver problems).
It is important to get help for skin picking disorder, especially because having skin picking also increases the chance that one might develop other conditions such as depression, anxiety, obsessive compulsive disorder (OCD).
The good news is that there are various treatments for skin picking disorder, which includes:
Counseling/therapy (aka talk therapy): There are many types of professionals that can offer talk therapy, including psychologists, social workers and psychotherapists. They can offer strategies such as:
Self-Compassion: Self-compassion is about helping accept that you are imperfect. There will always be imperfections in your skin, your body… And its okay, because everyone is imperfect, and that is part of being human. You wouldn’t be human if you weren’t imperfect.
Habit reversal training: The therapist helps you identify the situations, stresses, and other factors that trigger the skin picking. Then your therapist will help you find other things to do instead of skin picking.
Do you pick when you are bored? Always have something you can fidget with, e.g. stress ball, prickly stress ball.
Do you pick when you are cooking? Have a utensil so that your hands are never free to pick.
Do you feel an urge to pick while in public? Put your hands in your pockets.
Stimulus control: This is about changing your environment to reduce skin picking.
E.g. Do you pick because you feel your skin and feel it has a blemish? Try wearing gloves or Band-Aids so that you cannot feel your skin.
E.g. Do you pick because you see something on your face? Hide or cover mirrors to avoid triggering temptation.
- The use of mild soaps and lubricants along with decreasing the frequency of washing may help with itchy skin.
- Topical steroid creams to decrease redness, swelling and itchiness.
- Need help healing the skin?
- Petrolatum ointment and ceramide-based creams are good for helping repair the skin without the risk of irritant or allergic contact dermatitis.
The use of physical barriers such as an Unna sleeve makes it harder to pick, and can thus help prevent picking in otherwise easily accessible areas.
- The use of physical barriers such as an Unna sleeve makes it harder to pick, and can thus help prevent picking in otherwise easily accessible areas.
Specific serotonin reuptake inhibitors (SSRIs) can be used, such as:
- Fluoxetine (tradename Prozac)
- Citalopram (tradename Celexa)
- Escitalopram (tradename Cipralex)
- Fluvoxamine (tradenameLuvox)
- Sertraline (tradenameZoloft)
- Antihistamines to reduce itchiness
Glutamate-modulating drugs (such as N-acetylcysteine (NAc))
- Antibiotics to treat infection.
- Specific serotonin reuptake inhibitors (SSRIs) can be used, such as:
If you think you have skin picking disorder, see your family physician to start, who can help:
- Make sure that there aren’t any medical conditions that may be contributing.
- Deal with skin lesions, wounds, or scars caused by the repetitive picking.
There are various types of professionals who may be able to help such as:
- Psychiatrists: Your doctor can refer you to a psychiatrist.
- Psychologists and social workers: Can provide CBT and/or HRT.
- Dermatologist: May be helpful if there are problems such as infection, scarring, disfigurement or another skin condition.
Looking for a list of professionals?
- The Trichotillomania Learning Center keeps a list of trained professionals. If there is no one on the list near you, you can also look for a therapist who treats obsessive-compulsive disorder (OCD). They are often trained in similar types of treatment.
Sally builds up the courage to speak to her family doctor about her skin picking. She is relieved to find out that she is not alone, that other people have this condition too. Her family doctor does some tests to rule out other medical conditions that may be contributing. Her family doctor suggests a nearby publicly funded service that provides counseling, and it makes a huge difference in helping her cope and deal with stress. She learns how to be more self-compassionate and accept that she is not perfect. The urges still come from time to time, but she's able to keep herself from picking.
The Trichotillomania Learning Center
Online resource and community for those with dermatillomania, including an App for self-monitoring of skin picking.
Canadian BFRB (Body-Focused Repetitive Behaviours) Support Network
Written by Dr. Tania M. Fantin, Family Medicine Resident, Class of 2017 and Dr. Michael Cheng (psychiatrist). Reviewed by members of the eMentalHealth.ca Primary Care Team, which includes Dr’s M. St-Jean (family physician), E. Wooltorton (family physician), F. Motamedi (family physician), and M. Cheng (psychiatrist).
This information is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your qualified expert or health provider. Always contact a qualified expert or health professional for further information in your specific situation or circumstance.
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Date of Last Revision: May 23, 2021