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Also known as excoriation disorder or dermatillomania, this condition leads to repeated, compulsive picking of skin that causes notable damage and scarring of the skin and lips. It is commonly misdiagnosed as obsessive-compulsive disorder (OCD) due to the compulsive nature of the behavior. OCD usually involve persistent, intrusive thoughts (obsessions) leading to actions that satisfy those urges (compulsions). Skin picking disorder however, usually lack the obsessional thoughts present in OCD and do not respond to standard OCD treatment.
What are the Symptoms of Skin Picking Disorder?
- Recurrent skin picking resulting in skin lesions
- Repeated attempts to decrease or stop skin picking
- The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The skin picking is not due to the physiological effects of a substance (ex. illicit drugs) or another medical condition (ex. scabies)
- The skin picking is not better explained by symptoms of another mental disorder (ex. delusions, hallucinations in a psychotic disorder, attempts to improve a perceived defect or flaw in appearance in body dysmorphic disorder, stereotypies (involuntary repetitive movements) in stereotypic movement disorder, or intention to harm oneself in non-suicidal self-injury)
The onset of this disorder often occurs in adolescence or adulthood and many start this behavior with onset of skin conditions such as acne. However, most continue this behavior even after their acne clears. Similar to trichotillomania or hair pulling disorder, individuals who skin pick spend a significant amount of time each day picking. Face is the most commonly reported site, but hands, fingers, arms, and legs are also frequently targeted.
Treatment
Behavioral therapy and psychotherapy are considered first line treatment and although evidence for their benefit is still small, it is promising. Specific types of behavioral therapy are habit reversal therapy (HRT), acceptance and commitment therapy (ACT), dialectical behavior therapy (DBT), and cognitive behavioral therapy (CBT). Currently, there is no medication that has been approved for treatment of hair pulling or skin picking disorders. Results from one small double-blind, placebo-controlled study of adults showed olanzapine (Zyprexa) to be promising but given the overall unfavorable side effects of such medications, the decision to use it will need to be carefully considered. Currently, there is no comparable data for use of olanzapine in children and adolescents.
Treatment of co-occurring conditions such as anxiety, depression, and ADHD may actually result in improvement of hair pulling and skin picking behavior.
If left untreated, most cases often become chronic although the severity of symptoms may wax and wane. When diagnosed early and treated appropriately, as many as 50% of individuals may experience symptom reduction for at least 3-6 months at a time. Continued booster therapy sessions may be necessary for longer reduction of symptoms.
📚 References
This content was adapted from:
https://pmc.ncbi.nlm.nih.gov/articles/PMC9063575/
PL, MD 3/2026, Behavioral Health Committee