Skin Picking Disorder (Excoriation)

Many people pick at their skin once in a while, but sometimes it crosses the line into a condition called skin picking disorder (excoriation).

When this happens, picking at the skin -- for example, picking a scab or the skin around your nails -- can become so frequent and intense that it causes bleeding, sores, and scars.

Some people with this disorder repeatedly scratch to try to remove what they see as some kind of imperfection in their skin.

What Are the Signs of Skin Picking Disorder?

It's hard to say exactly when skin picking changes from a mild, nervous habit to a serious problem that needs treatment. It may help to ask the following questions:

• 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?

How Does Skin Picking Disorder Develop?

Skin picking disorder happens in both children and adults. It can begin at almost any age.

Skin picking disorder often develops in one of two ways:

After some kind of rash, skin infection, or small injury. You may pick at the scab or rash, which causes more injury to the skin and keeps the wound from healing. More itching leads to more picking and more scabbing, and the cycle continues.

During a time of stress. You may absently pick at a scab or the skin around your nails and find that the repetitive action helps to relieve stress. It then becomes a habit.

Skin picking disorder is considered a type of repetitive "self-grooming" behavior called "Body-Focused Repetitive Behavior" (BFRB). Other types of BFRBs include pulling or picking of the hair or nails that damages the body.

It is classified in the DSM-V (a compendium of psychiatric diagnoses) as a type of obsessive compulsive disorder because of the compulsive urge to perform repetitive behaviors.

Treatment

Skin picking disorder is treated with therapy and medications.

There are two main kinds of therapy for skin picking:

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, such as squeezing a rubber ball. This will help ease stress and occupy your hands.

Stimulus control. This therapy involves making changes to your environment to help curb skin picking. For example, you might try wearing gloves or Band-Aids to help prevent feeling the skin and getting the urge to pick. Or you might cover mirrors if seeing facial blemishes or pimples brings on picking behavior.

Some psychiatric medications are occasionally used to treat skin picking disorder, but none are FDA-approved or well-established for this purpose. SSRIs (selective serotonin reuptake inhibitors) such as Prozac are the best-studied class of medicines for skin picking.

Early studies also have begun to examine the possible value of some anticonvulsant medicines, such as Lamictal (lamotrigine) and some supplements such as N-acetyl cysteine. There have even been studies looking at naltrexone, an opioid blocking medication.

If you think you have skin picking disorder, it may be hard to find a doctor who is experienced with this kind of issue. The Trichotillomania Learning Center keeps a list of professionals who are trained in therapy for BFRBs. If there is no one on the list near you, you can also look for a therapist who treats obsessive-compulsive disorder. They are often trained in similar types of treatment.

It is also a good idea to see your primary care doctor or a dermatologist about any skin lesions, wounds, or scars caused by the repetitive picking.

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