How to Treat Skin Picking Disorder (Excoriation)

Medically Reviewed by Zilpah Sheikh, MD on February 08, 2024
8 min read

Skin picking disorder is when you repeatedly and uncontrollably pick at your skin, sometimes resulting in injury and scarring. It's also called pathological skin picking, neurotic excoriation, dermatillomania, or psychogenic excoriation.



Dermatillomania vs. OCD

Dermatillomania is considered a type of obsessive-compulsive disorder (OCD), but differences exist. Unlike people with dermatillomania, those with OCD don't get a rewarding feeling or injure themselves while engaging in their obsessions or compulsions.

How common is it?

In the U.S., about 2% of people currently have skin picking disorder, and about 3% of people say they had periods of skin picking in the past.

The main symptom of dermatillomania is the impulse or urge to pick at your skin and that's impossible or extremely hard for you to resist. "Picking" may include any of the following:

  • Scratching
  • Digging
  • Squeezing
  • Rubbing

Most of us pick at our skin sometimes, but it becomes a disorder when you have the following signs and symptoms:

  • Skin picking to the point that it results in sores, bruises, or scratches on your skin
  • You've tried to stop and you can't
  • You feel upset or embarrassed or it's affecting your daily life

Most people with dermatillomania pick at their skin with their fingers or fingernails, but some people also use tweezers, needles, pins, or scissors. Some people will also use their teeth, for instance, to bite at their lips.

Automatic picking

Automatic picking occurs more or less without you thinking about it. You may do it while driving, watching TV, or reading. Experts think automatic picking may be a form of self-stimulation. Many people describe a feeling of relief when they pick at their skin, followed by feelings of anger and shame.

Focused picking

You are usually more aware of focused picking and may feel an urge to pick in a specific area. These urges can come in the form of ideas such as a need to remove irregularities like scabs, sores, or pimples, or physical feelings like skin itching or tingling. Experts think that focused picking may be an attempt to avoid feelings of discomfort or boredom.

The areas most affected by skin picking include the parts of your body you can easily reach with your hands, such as your:

  • Face (the most common site), scalp, and neck
  • Fingers, hands, and forearms
  • Thighs, calves, feet, and toes

There's probably no one cause for dermatillomania. Experts think several factors play a role, including:

  • Differences in brain structure. People with dermatillomania may have differences in the area of their brain that controls how they learn habits.
  • Stress, anxiety, or other conditions. Some people with stress, anxiety, or depression may soothe themselves by picking at their skin.
  • Genetics. You are more likely to have dermatillomania if your parents, siblings, or children also have the condition.

It's classified in the DSM-V (a compendium of psychiatric diagnoses) as a type of obsessive-compulsive disorder (OCD) because of the compulsive urge to perform repetitive behaviors. However, skin picking disorder and OCD aren't the same thing.

You may be more likely to get skin picking disorder if you have:

  • Trouble regulating your emotions
  • Low impulse control
  • Increased skin sensitivity
  • Low tolerance for skin irregularity

Your doctor will usually use a few different methods to diagnose your condition, including:

  • A physical exam to look for signs on your body
  • Questions about your medical history, life circumstances, and any behaviors that may be related
  • Diagnostic tests to help rule out other causes for your condition

To diagnose you with dermatillomania, your doctor will try to find out if you meet five criteria:

  • Ongoing or repeated skin picking
  • You've made attempts to stop or cut down
  • You have shame, embarrassment, or other negative emotions about skin picking that affect your work and social life
  • You're not picking your skin because of a medical or skin condition or the side effects of medicine or drugs
  • You don't have another mental health condition that causes you to pick at your skin

People with dermatillomania are more likely to have other medical or mental health conditions, such as:

  • OCD and related disorders, such as hairpulling (trichotillomania) or nail-biting
  • Depression
  • Anxiety disorder
  • Bipolar disorder
  • Prader-Willi syndrome (a genetic condition that affects the metabolism, body, and behavior)

Dermatillomania test

There is no one test for dermatillomania. Your doctor may do medical tests so they can rule out medical causes for your symptoms. Generally, your doctor can tell if you have it from your medical history, your symptoms, and a physical exam. They may also refer you to a specialist for diagnosis and treatment.

Skin picking disorder is usually treated with a combination of medicine and cognitive behavioral therapy.

The most helpful medicines include:

  • Antidepressants, usually with selective serotonin reuptake inhibitors (SSRIs). SSRIs that have been tested in people with dermatillomania include citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox, Faverin), and sertraline (Zoloft).
  • Anticonvulsants, such as lamotrigine, help you control your muscle movements.
  • Antipsychotics help you balance your brain chemicals.
  • Nutraceuticals, such as functional foods or supplements. One is N-acetylcysteine, which may help reduce your urge to pick at your skin.

Several kinds of therapy may be helpful, including:

  • Cognitive behavioral therapy, which teaches you coping strategies to help change your behaviors.
  • Habit reversal therapy, which helps you become more aware of your behaviors so that you can break bad habits. For instance, your therapist can help you find other behaviors that will ease your stress and occupy your hands, such as squeezing a rubber ball.
  • Group therapy and peer support.
  • Acceptance and commitment therapy, which helps you accept negative emotions and teaches you positive coping mechanisms.

If you have severe damage to your skin or your tissue underneath, your doctor may send you to a specialist to talk about surgery and skin grafts.

Complications of skin picking can include:

  • Scars and disfigurement
  • Infections and ulcerations (including scars and scabs)
  • Blood loss
  • Blood poisoning from bacteria

Dermatillomania scars

Scars are your body's way of healing and rebuilding your skin. You will likely get scars in areas where you often pick at your skin. And if you're constantly picking at your sores and peeling off your scabs, you will make them worse. This can cause you extra anxiety because the scars may get deeper and bigger.

Dermatologists have several techniques that can minimize your scars, but no technique can completely remove one. It's best to get your skin picking under control before you look for ways to minimize your scars. In the meantime, you can take some steps to help prevent deep, large scars, such as:

  • Keep your skin and any sores clean. For most sores that aren't too deep or large, washing with a mild soap should keep it clean enough.
  • Use petroleum jelly to keep your sores moist. This will help prevent a scab from forming. Sores with scabs take longer to heal and can get itchy, which will make you want to pick more.
  • Cover your sores with a bandage. If you're sensitive to adhesive, use a gauze pad with paper tape, or use silicone gel or hydrogel sheets. Silicone gel or hydrogel sheets may be especially helpful if your sore is large or very red.
  • Change your bandage daily to keep your sores clean while they heal.
  • Use sunscreen with SPF 30 or higher on your sore after it has healed. Sun protection may help reduce discoloration and help your scar fade faster.

People with dermatillomania often feel ashamed or embarrassed so they don't seek out treatment. But dermatillomania isn't just a bad habit. It's a medical condition that you may need help to treat. Getting the help you deserve can help you ease the anxiety, shame, and embarrassment that you feel when you pick at your skin. Just as you wouldn't hesitate to seek help with a broken bone or a bad burn, you shouldn't hesitate to seek help for skin picking if it's causing you distress and disrupting your life.

Several different methods may help you reduce how often you pick at your skin or keep you from hurting yourself if you do pick. Try out these tips:

  • Wear Band-Aid or finger puppets on your fingers or put gloves on your hands. Every time you start to pick, the physical barrier will remind you not to and will cut down on the satisfaction you get from picking with your fingers.
  • Tell your friends and family that you're trying not to pick your skin so they can help let you know when you're doing it.
  • Wear an elastic band around your wrist and snap it if you feel the urge to pick. This may help you realize how often you feel the urge to pick and what your triggers are.
  • Figure out when and where you tend to pick your skin. If possible, avoid these times and places.
  • Try to resist picking your skin, and then extend the amount of time you can go without picking.
  • Rather than picking at your skin, do some positive self-care, such as applying moisturizer.
  • Keep your skin clean and your nails short.
  • Don't keep tweezers, pins, or other tools that you might use to pick at your skin in easy reach.

Dermatillomania fidget toys

Fidget toys or handcrafts such as knitting or beading can also help keep your hands busy. This is a technique called competing response. It's a way of keeping yourself busy or giving yourself another way of self-soothing than picking at your skin.

There are all kinds of ready-made fidget toys or other things you can use as fidgets, such as fidget spinners, beaded bracelets, silly putty, play dough, soft rubber balls, bubble wrap, spinner rings, and bottle caps with plastic liners inside. Experiment with several different types to see what satisfies your need to pick without damaging your skin.

What triggers skin picking disorder?

Most people have several triggers to pick. Common triggers include stress, anxiety, time away from your scheduled activities, and feeling bored, tired, or angry. You may also be triggered to pick by the feel or look of your skin.

Is skin picking related to OCD or anxiety?

Skin picking is a mental health condition that's related to OCD. Skin picking can be triggered by feelings of anxiety.

How do you fix skin picking disorder?

Treatment usually involves a combination of medicine and therapy. It is a lifelong condition, but with treatment, you can go into remission. This means that you won't feel the urge to pick or can avoid doing it for long periods.

Is skin picking related to ADHD or OCD?

Skin picking is related to OCD, but the urge to pick can be triggered by symptoms of ADHD, such as boredom or trouble regulating your emotions.

Dermatillomania is when you can't stop picking at your skin, sometimes to the extent of causing injury and scarring. This can make you feel ashamed, embarrassed, or guilty. Your doctor can help you figure out what triggers you to pick your skin and how to change your behaviors, which can help you feel better. With help, most people can get relief from their urges to pick at their skin.