“Skin-picking can be a sensitive subject. In the aesthetic dermatology industry, we see it frequently amongst our patients, many of whom are surprised to hear it is an actual thing and that they are not alone.” – Dr. Sarah Boxley, Medical Director, The Skin Clinic Fremantle
We have collated the information below with an aim of educating sufferers and their family members, and to offer guidance towards strategies that can help. So please read on if you are affected, fascinated or otherwise interested in learning more about this ……
Also known as excoriation disorder, or compulsive skin picking, dermatillomania is a psychological condition that is expressed in the form of repetitive touching, scratching, picking, and digging at one’s own skin. It is an impulse-control disorder and one of several body-focused repetitive behaviors (BFRB) currently classified in the DSM-5 as Obsessive Compulsive and Related Disorders.
Dermatillomania affects up to 5% of the population and approximately 75% of those affected are female. However, not all people who pick their skin have dermatillomania. The difference between dermatillomania and normal picking at skin imperfections and irregularities, is that the behaviour is chronic, results in tissue damage, and causes the person distress, dysfunction, and often feelings of embarrassment and even shame.
How do I know if I have dermatotillomania?
Most people pick at their skin from time to time, but you may have skin picking disorder if you:
- can’t stop picking your skin
- cause cuts, bleeding or bruising by picking your skin
- pick moles, freckles, spots or scars or try to “smooth” or “perfect” them
- don’t always realise you are picking your skin, or do it when you are asleep
- loose track of time when you are picking your skin
- pick your skin when you are feel anxious or stressed
You may pick your skin with your fingers, fingernails, teeth or with tools like tweezers, pins or scissors.
Repetitive skin picking can also extend to pulling, scraping, and even biting both healthy and damaged skin from various parts of the body, though most often on the face, hands, fingers, arms, and legs. Skin picking commonly begins in adolescence (but can occur at any age) and can result in visible skin damage such as lesions, discolouration, open wounds, scars, and infections. Dermatillomania is generally a chronic condition, though symptoms may arise and disappear from time to time. Those with dermatillomania exhibit a wide range of picking behaviours. Some pick as little as a few times per day, briefly without even knowing it. Others can spend hours picking at individual areas. Skin picking is almost always done with the fingernails. In some cases, tweezers or other tools are used.
Skin picking can cause a number of complications. Infection at the picking site is perhaps the most prevalent. Tissue damage is a close second. Some cases can be severe enough to warrant skin grafting. Permanent scarring and physical disfigurement are common effects of skin picking. Dermatillomania can cause mental effects as well as physical effects. Anxiety, depression, shame, fear of exposure, and embarrassment over the condition usually leads to attempts at covering up the skin with makeup, clothing or by other means, and can also interfere with normal social interactions resulting in uncomfortable relationships with family and friends. At the same time, these feelings loop around on themselves and increase the likelihood of self-harm including continued picking.
Dermatillomania is not diagnosed when the symptoms are caused by another medical or psychiatric condition. For instance, skin picking can also occur with with dermatological conditions, autoimmune disorders, opiate withdrawal, and developmental disorders such as autism.
Causes of Dermatillomania
It appears there may be a genetic link to dermatillomania, since some people appear to have an inherited tendency to BFRBs such as skin picking and hair pulling, as well as higher-than-average rates of mood and anxiety disorders in first-degree relatives. Other factors, such as individual temperament, stress and age appear to play roles in the development of the condition. Chronic skin picking behaviour often coincides with the onset of puberty Dermatillomania may also be associated with perfectionism that leads to over-grooming, or used as a means of avoiding stressful events or releasing tension that builds up as a result of negative emotions such as impatience, frustration, dissatisfaction and even boredom.
Things you can try to stop picking your skin
- keep your hands busy – try squeezing a soft ball or putting on gloves
- identify when and where you most commonly pick your skin and try to avoid these triggers
- try to resist for longer and longer each time you feel the urge to pick
- remove or cover mirrors in your house
- care for your skin when you get the urge to pick it – for example, by applying moisturiser
- tell other people – they can help you recognise when you are picking
- keep you skin clean to avoid infection
- do not let your nails grow long – keep them trimmed
Treatments for Dermatotillomania
For those who have made repeated attempts to stop picking on their own and have been unsuccessful, it may be time to seek professional treatment.
There are several different types of pharmacological treatment for skin picking disorder, although none of these are approved as first-line treatment for skin-picking. The most common type of treatment is Selective Serotonin Reuptake Inhibitors (SSRI). These have been shown to be highly effective in treatments for OCD. Because of this, they have also been used for treating dermatillomania although to date there are no specific clinical studies supporting the use of SSRIs for this condition. Doxepin, clomipramine, naltrexone, andolanzapine, and pimozide all may be effective in the reduction of skin picking behaviours. Nutraceuticals, such as n-acetyl cysteine (NAC), may also be of help.
Behavioural treatments for dermatillomania are far more common than pharmacological treatments. These treatments include cognitive-behavioural therapy (CBT), acceptance-enhanced behavioural therapy, acceptance and commitment therapy, and habit reversal training. Habit reversal, in particular, has been shown to be effective.
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