Skin picking (excoriation) disorder: what is it, causes, diagnosis, treatment

Many people pick at their skin from time to time—for instance, at pimples, scabs, or fingernail cuticles. Some conditions can also cause people to pick at their skin, like a dermatological disorder or using certain types of drugs. But picking at your skin from time to time is different from skin picking disorder, a distressing psychological disorder that causes people to continually pick at their skin.

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Skin picking disorder is a neuropsychiatric disorder that is also called pathological skin picking, neurotic excoriation, dermatillomania, or psychogenic excoriation. People with this disorder pick at their skin repetitively and compulsively—they want to stop picking but are unable to do so. This constant picking results in lesions (wounds) to the skin. People with skin picking disorder are often distressed about having it and feel that it gets in the way of their everyday activities.

Skin picking is classified as an impulse control disorder, related to (but not a type of) obsessive-compulsive disorder (OCD) (Grant, 2015; Jenkins, 2019). It’s similar to OCD in that people with the disorder often pick their skin repetitively in response to recurrent thoughts about doing so or urges to touch or pick their skin.

This disorder is relatively common. Studies estimate between 1.4% and 5.4% of the population has it (Lochner, 2015). A sampling of over 10,000 adults found that women are slightly more likely than men to have it (Grant, 2020). Skin picking disorder is thought to be underrecognized by medical professionals.

People with this disorder pick at their skin in different ways (Lochner, 2017). They may pick skin from one or more parts of their body. One study found that people picked at an average of 4.5 body sites (Grant, 2015). The most common areas are the face, head, cuticles, back, arms and legs, and hands and feet. People with the disorder may pick at either healthy skin or irregularities (like pimples).

Most often, individuals with the disorder use their fingers and fingernails to pick their skin. But they may also bite at their skin or use tools like tweezers and scissors. To dispose of the skin, they may throw it in the trash or on the floor, or eat it.

It’s not clear what the root cause of skin picking disorder is. It may have biological or environmental causes, or both. Skin picking disorder can begin in childhood or adulthood. Frequently, it starts in adolescence, when puberty begins, often when acne appears (Lochner, 2015).

People may pick at their skin out of boredom or an attempt to deal with challenging emotions such as anxiety, sadness, and anger. Sometimes, people aren’t even aware that they’re picking their skin. There can be a number of triggers, such as stress, time away from scheduled activities, and feeling tired (Grant, 2015).

Feelings of guilt or shame often follow skin picking episodes.

Skin picking disorder can have some severe consequences. It can be harmful to a person’s emotional, physical, and social health (Lochner, 2015).

The most likely physical effect of skin picking is scarring—repetitive picking can leave permanent marks on the skin. In some cases, this behavior can also lead to infections in the skin, which may require antibiotics, hospitalization, or even surgery in extreme cases. Many people with skin picking disorder avoid social activities and intimate relationships due to low self-esteem (Grant, 2015). 

The good news is there are treatments available. If you’re living with this disorder, it’s important that you take it seriously and get the help you need to work through these issues and avoid any dangerous consequences. 

Skin picking disorder is often accompanied by depression and/or anxiety. Frequently, skin picking disorder co-occurs with trichotillomania (hair-pulling disorder), in which people compulsively pull out their own hair. One study found that the mental health disorders that often accompany skin picking disorder include generalized anxiety disorder (63.4%), depression (53.1%), and panic disorder (27.7%) (Grant, 2020).

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the following statements must be true for a diagnosis of skin picking disorder:

• The skin picking causes lesions.

• The person wants to decrease or stop picking.

• Picking causes the person distress or gets in the way of social life, work, or some other part of the person’s life.

• The picking isn’t caused by the physical effects of using a drug (such as cocaine) or a medical condition.

• The picking can’t be better explained by another mental health condition (like picking to improve the person’s appearance or something seen as a physical defect, as can happen in body dysmorphic disorder)

The first step in diagnosis is a complete psychiatric exam to see if the conditions above are present, and if there are any other mental or physical conditions present.

Cognitive behavioral therapy (CBT) seems to be the most effective treatment for skin picking disorder. Three types of CBT are beneficial for this condition (Lochner, 2017):

• Habit reversal training (HRT)

• Comprehensive behavioral model (ComB) treatment

• Acceptance and commitment therapy (ACT)

Skin picking disorder can also be treated with drugs (pharmacotherapy). These drugs may be used:

• N-acetylcysteine or olanzapine (Grant, 2015)

• SSRIs (selective serotonin reuptake inhibitors) (Fama, 2021)

• Lamotrigine (an anti-seizure medicine)

Many people are unaware that treatment for skin picking disorder can be very effective. If you’ve tried to stop picking your skin but haven’t been able to do so, and if skin picking is causing you to feel shame or embarrassment and getting in the way of your everyday life, consider seeing a mental health professional to help you find success.

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Current version

October 20, 2021

Written by

Alison Dalton

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.