Medicines for Skin picking disorder

What it is

Skin picking disorder (also called dermatillomania or excoriation disorder) is a condition in which a person repeatedly picks at their skin to the point of causing damage, and finds it very difficult to stop. It is one of a group of related conditions called body-focused repetitive behaviours (which also includes hair pulling, known as trichotillomania). While many people pick at their skin occasionally (for example a spot or a scab), in skin picking disorder the behaviour is repeated, difficult to control, causes damage to the skin (such as sores, scarring, or wounds), and causes distress or affects the person’s life. People may pick at healthy skin, or at spots, scabs, blemishes, or irregularities, often on the face, arms, hands, or elsewhere, and may use their fingers or nails or sometimes other implements. The picking can be automatic (done without full awareness, for example while concentrating or watching television) or more focused (in response to an urge, or to feelings such as stress, anxiety, or boredom, or to a sense of an imperfection), and people often experience a build-up of tension and a sense of relief or gratification during or after picking, followed by regret or distress. Skin picking disorder can cause skin damage, scarring, and sometimes infections, and can also cause significant emotional distress, shame, and impact on daily life and social situations, and people may go to lengths to hide the behaviour or the damage. It can be linked with stress and anxiety, and can occur alongside other conditions. Importantly, skin picking disorder is a recognised condition, not simply a "bad habit" or a lack of willpower, and it is treatable — psychological therapies, in particular, can help people gain control over the behaviour, and support is available. The key messages are that skin picking disorder is a recognised, treatable condition (not a character flaw), that it causes skin damage and distress and is hard to stop, and that psychological therapies and support can help.

How it is treated

Skin picking disorder is treatable, and the main approach is psychological therapy (particularly behavioural therapies), along with support and, in some cases, other treatments and measures; a compassionate, non-judgemental approach is important. Because skin picking disorder is a recognised condition and not simply a lack of willpower, understanding this and approaching it with self-compassion (and, from others, without judgement) is helpful, as shame can make it harder to seek help. The most helpful treatments are psychological, particularly behavioural approaches such as habit reversal training and other elements of cognitive behavioural therapy (CBT) adapted for body-focused repetitive behaviours: these help the person become more aware of the picking and its triggers, develop alternative responses to the urges (for example doing something else with the hands), manage the situations and emotions (such as stress, anxiety, or boredom) that trigger picking, and reduce the behaviour over time. Practical strategies can support this — such as identifying and managing triggers, keeping the hands occupied, making the behaviour harder (for example keeping nails short, or covering areas), and reducing access to implements. Addressing any underlying or associated stress, anxiety, or other mental health conditions is also important, and treating these can help. Support is available, including from a GP (who can advise and arrange access to therapy), and from resources and support organisations for body-focused repetitive behaviours, which provide information and peer support. Where the skin has been damaged, caring for the skin and treating any infection are part of care, and a dermatologist may be involved for skin problems. In some cases, medication may be considered, particularly where there is associated anxiety or another condition, as advised by a doctor. It is worth seeing a GP if skin picking is causing damage, distress, or affecting your life, or if you are finding it hard to stop, so support and treatment can be arranged. The reassuring messages are that skin picking disorder is a recognised, treatable condition (not a character flaw or simply a bad habit), that psychological therapies (particularly habit reversal and CBT-based approaches) can help people gain control over it, and that support is available — so seeking help is a positive step.