Excoriation disorder, also known as dermatillomania, is a skin-picking condition. People with excoriation disorder will pick, scrape, rub, scratch, or pull at their skin, sometimes to the point where it begins to hurt or cause damage to the skin tissue.
Skin picking can be a symptom of many other conditions.
But skin picking can be a symptom of autoimmune conditions, too. The symptoms of some autoimmune conditions create a situation where skin picking becomes a regular habit.
Let’s take a look at the connection between autoimmune conditions and excoriation disorder.
The “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)” defines excoriation disorder as a type of obsessive-compulsive disorder (OCD). According to the Anxiety & Depression Association of America, it falls into a category of symptoms called body-focused repetitive behaviors (BFRB).
People with excoriation disorder regularly spend several minutes picking at their skin, or they may pick continuously for hours. People with the condition often tend to pick their face, but they may focus on other areas of their body, too.
The motivation behind why you pick may vary, but people with this condition find it difficult to control the impulse to do it. To diagnose excoriation disorder, a doctor needs to determine that the damage to your skin is due to compulsive skin picking and not an underlying skin condition.
Skin-picking disorder often occurs along with other conditions, including:
- anxiety disorders, including panic disorder and post-traumatic stress disorder (PTSD)
- attention deficit hyperactivity disorder (ADHD)
- autism spectrum disorder
- body dysmorphia, which can be a symptom of other mental health conditions or a condition on its own
- bipolar disorder
- borderline personality disorder
- substance use disorder
Autoimmune conditions that affect your skin can cause excoriation disorder to develop. This is more likely if you already have a history of other mental health or psychological conditions.
Many of these conditions are linked to each other, known as comorbidities. This means a person will often have several of these conditions in addition to excoriation disorder.
Rheumatoid arthritis (RA) is an autoimmune condition linked to inflammation in your joints. This inflammation can lead to itching on your skin at the site of the affected areas. Itching from RA can then progress to skin picking.
Lupus is an autoimmune condition that causes inflammation. If you have lupus, you can develop lesions on your lower legs or the ends of your fingers and toes. These lesions may be itchy, and scratching them can become a compulsive behavior.
Psoriasis is an autoimmune condition that causes patches of raised scales on your skin. Inflammation causes these scales. They can be itchy and discolored. The urge to pick off these scales can become excoriation disorder.
One of the symptoms of MS is the sensation of things crawling on your skin. This sensation can lead to an urge to scrape or itch.
Type 1 diabetes
Type 1 diabetes is caused by an autoimmune response to cells in your pancreas. This type of diabetes often causes lesions to develop on your skin. Picking at these lesions can become a compulsion.
When you have diabetes, small ulcers or open wounds can quickly progress to something more severe. Skin-picking disorder can make those complications worse.
Hashimoto’s thyroiditis is an autoimmune condition that causes your white blood cells to attack your thyroid, limiting its function. That means it has an impact on your hormones and metabolism.
Hashimoto’s doesn’t directly lead to skin lesions. But it is a risk factor for several other conditions that can, such as RA and type 1 diabetes.
Dermatomyositis causes muscle inflammation as well as a distinctive skin rash. A viral infection or cancer can trigger it. The rash can be itchy and cover large portions of your body.
People with this condition may try to scratch away dry patches and end up repeating the behavior over and over.
While not technically an autoimmune condition, eczema is still connected to the way your immune system functions. Eczema flares can be naturally itchy, and scratching and peeling off flakes from eczema can become a compulsive behavior.
Symptoms of excoriation disorder include:
- open wounds where you’ve picked your skin
- feeling a compulsive urge to pick your skin that you cannot resist
- hyperfocus on the idea that you can cleanse your skin or remove what you see as impurities
- a consistent feeling of itching coming from your skin
- scarring on your face, arms, and other parts of your body
- repeated attempts to stop picking that are ultimately not successful
Sometimes, shame accompanies the compulsion to pick your skin. You may feel guilt for harming your body with skin picking, even though you don’t feel like you can stop.
Excoriation disorder treatment can require a two-pronged approach.
If you have an autoimmune disorder, treating the underlying condition is necessary to ease skin symptoms like itching. Without treating the underlying trigger of excoriation disorder, the symptoms will come back.
However, treating an underlying autoimmune condition isn’t enough by itself. People with severe excoriation disorder will pick open areas of skin that have healed. Mental health treatments are often necessary to help modify skin-picking behaviors.
Medications used to treat excoriation disorder aim to limit the amount of compulsion you feel. These medications may include:
- antipsychotic medications, such as olanzapine and aripiprazole
- selective serotonin reuptake inhibitors, such as fluoxetine or escitalopram
- tetracyclic antidepressants, such as mirtazapine
- N-acetyl cysteine
- prescription topical ointments meant to limit itching, such as corticosteroid
- anticonvulsants like lamotrigine
You may benefit from cognitive behavioral therapy (CBT) or habit reversal therapy (HRT) to help treat symptoms of excoriation disorder. These treatments focus on changing your pattern of thinking.
- healed skin lesions
- reduction in skin-picking behaviors
- reduction in symptoms of depression or anxiety
More research is needed to clearly demonstrate how effective CBT and HRT may be for excoriation disorder.
You may want to supplement your prescribed treatment for excoriation disorder with mental health strategies that you can practice at home. At this point, though, the evidence supporting these remedies is mostly anecdotal.
You may consider:
- meditation, which may help ground you and help lower the urge to pick your skin
- mindfulness, which may help you feel less anxious
- yoga or another meditative exercise practice
- spending time outside
Keep in mind that these home remedies may help your mental health, which can help you reduce skin-picking behaviors. But it’s important to speak with a healthcare professional if:
- Your skin-picking is affecting your quality of life.
- You’re picking healthy skin.
- You have lesions or a visible infection.
Autoimmune disorders have been linked to excoriation disorder, a type of OCD. Underlying inflammation, itching, and rashes can lead to skin picking, which then progresses to compulsive behavior. For people who already have mental health conditions that put them at risk, autoimmune symptoms can trigger excoriation disorder.
Medications and therapeutic approaches can help you manage excoriation disorder. Without treatment, this condition can lead to complications such as infections and scarring. Speak with your doctor if you are experiencing the urge to pick your skin.