What Is Excoriation (Skin Picking) Disorder?

Understanding the signs and symptoms of skin-picking disorder can help you recognize whether certain behaviors are the result of “normal” picking, or if they may signify something more serious.

For example, occasional picking is rarely problematic. Scabs often itch while the skin heals, leading many people to scratch at their skin. And despite advice to the contrary, many people pick at pimples and blackheads, too.

People with skin-picking disorder, however, may pick at scabs, bumps, pimples, or other skin lesions until they bleed again or become inflamed. They may also pick at the skin around their fingernails and toenails.

Sometimes, people with the disorder let the picked areas heal only to pick them again. It’s a cycle of habit and impulse that can be challenging to overcome.

Other signs and symptoms of skin-picking disorder include:

• Trying to remove “imperfections”: Some people repeatedly scratch skin or try to rub out “imperfections” they think they see in their skin. This, too, can cause additional lesions, cuts, and sores.
• Spending large amounts of time picking: Some people with this condition will pick at their skin several times a day. Others may pick for several hours at a time. Either way, the behavior can be a significant disruption to their social and professional lives.
• Developing scars and infections from frequent picking: The disorder can lead to infections, lesions, and scars that last for long periods of time. Infections may require treatment with antibiotics.
• Avoiding public events because of their skin: Frequent picking can leave skin covered in lesions and scars. Some people with this condition may avoid the beach, gym, or venues that require less clothing because of their skin’s appearance.

Skin-picking disorder is a repetitive “self-grooming” behavior. It’s also called a body-focused repetitive behavior (BFRB). Other BFRBs include pulling hair or picking nails.

Skin-picking disorder is classified as a type of OCD. The compulsive urge to pick is often too powerful for many people to stop on their own. The more a person picks at their skin, the less control they have over the behavior.

It’s unclear what causes a person to develop this disorder.

The disorder often begins after one of two events or stimuli:

• An infection, injury, or wound starts healing and creates a scab. The itching causes the person to scratch and pick. The new wound or lesion starts to heal and creates another scab. That begins the cycle of picking.
• The behavior is a stress relief habit during a time of stress. The repetitive action and control that skin picking gives may provide relief from other events that can’t be controlled.

Skin-picking disorder occurs in both children and adults. It can begin at almost any age, but it typically appears first in adolescence or at the onset of puberty. Women are more likely to develop it than men.

Several conditions commonly occur alongside skin-picking disorder. These illnesses or disorders may be symptoms of a condition, or they may share many common underlying risk factors.

These co-occurring illnesses include:

• Obsessive-compulsive disorder (OCD): This mental health disorder often causes repetitive behaviors that greatly interfere with a person’s quality of life.
• Body dysmorphic disorder: People with this body-image disorder experience obsessive negative thoughts about how their body looks. This can lead to skin picking to remove “imperfections.”
• Major depressive disorder: Depression can lead to a host of behaviors, including skin picking.
• Trichotillomania (hair-pulling): Approximately 38 percent of people with skin-picking disorder also experience this condition.
• Other BFRBs: Although hair-pulling is the most common co-occurring BFRB, others are possible. This includes nail biting, biting the lips until they bleed, and chewing on the inside of your cheeks.

Skin-picking disorder can’t be self-diagnosed. Although you may suspect your symptoms are caused by skin-picking disorder, your doctor will want to rule out any other underlying conditions before making a diagnosis.

After performing a physical exam, your doctor will ask you about your behaviors and the feelings you have while performing the habit. They’ll also determine whether the lesions or scabs you’re picking are the result of a skin disorder or condition like eczema or psoriasis.

If your doctor suspects skin-picking disorder, they may refer you to a mental health professional. Family medicine doctors or internists may make this referral if they think the skin picking is the result of stress, anxiety, or OCD.

The treatment options available for skin-picking disorder fall into two main categories: medication and therapy.

Therapy

A mental health professional or counselor can help you identify the triggers that lead to skin picking. Then, together, you can develop ways to stop the behavior when you feel these triggers.

This may include learning to use healthier behaviors when you want to pick your skin. For example, squeezing a stress ball, playing with a Rubik’s cube, painting, or other behaviors that occupy your hands are sometimes used to stop picking.

A mental health expert may also help you learn to resist things in your environment or on your body that make you more likely to pick. Wearing gloves or adhesive bandages to cover scabs or cuts may also help you avoid picking.

Medications

Antidepressants may help ease self-picking behaviors. Selective serotonin reuptake inhibitors (SSRIs) are most commonly prescribed for this condition.

Other medications, including psychiatric and anticonvulsant drugs, may be prescribed for “off-label” use. This means that although the medication is primarily used to treat a different condition, it may also be used to treat skin-picking disorder.

Once a diagnosis has been made, your doctor will work with you to develop a treatment plan. Finding a treatment plan that works for you may take a process of trial and error.

Although treatment can help you manage the symptoms and quash the behaviors, you may experience periods when you pick again. This can happen even after long periods of stopping the behavior.

That doesn’t mean you can’t “overcome” the disorder. It just means that you and your doctor may need to revisit your treatment plan and update it to suit your needs.

As you take steps toward management, there are a few things you can do to help steer your treatment plan:

Find a support group in your community. This group of people will understand your experience and can support you as you try to find a treatment plan that works for you. They can also help you understand the course of the disorder and what you might expect in the future.

Ask a mental health expert or therapist for some guidance. Your hospital’s education outreach office may have a list of experts and groups for you to contact.

Above all else, be supportive of yourself. Set goals for yourself, and celebrate when you reach them. However, remember that, in the beginning, success may be slow-going. Boost yourself for every small accomplishment, and show yourself some grace if you don’t meet a certain goal.