ACT or acceptance & commitment therapy involves the integration of mindfulness & behaviour change strategies to help the affected person to acknowledge and accept unwanted and unpleasant emotions that trigger skin picking.

An example is to modify picking & replace it with habitual actions that are less damaging, example is patting or stroking the area. I know it sounds far-fetched, but with dedication & persistence your skin picking can be treated.

Disclaimer: Psychological exercises are given by psychologists. Dermatologists do not prescribe this therapy, whilst psychiatrists will usually prescribe medication. Ideally you should be in the care of a medical dermatologist (excludes organic causes), psychiatrist (prescribes you neurotropic medications) & psychologists (prescribes mental exercises).

Psychiatrists are at the forefront of treating skin picking disorders. Put bluntly, they prescribe medication that can augment the coping mechanisms & strategies taught by psychologists.

Medications can alter your thought processes & neurological firing to decrease the urge to pick. Most patients are on medications for 2-6 months, in some cases over 12-24. Be guided by your psychiatrist. Some dermatologists with an interest in psych dermatology may take on this role.

I think acne excoriee is markedly different from true skin picking disorder. I understand many people group these two conditions together. Hear me out.

Acne lesion picking also known as excoriated acne starts off with acne lesions (often deep, as in hormonal jawline acne). Secondary picking ensures. Hence if the substrate of picking is cured, this condition is cured. True skin picking disorder has no primary substrate. For more on how to cure & treat picking acne, refer to the page on acne excoriee. 

Disclaimer: I used to treat this disorder a decade ago, now my focus is on the management of severe scarring. If you have acne, the treatment of choice is medical & not surgical. Please see one of my colleagues at Clinic Cutis.

If you view skin picking disorder as a medical condition, much like obsessive compulsive disorder, then medical therapy coupled with psychotherapy is the fastest way to cure. Psychiatrists prescribe the following types of medication.

• SSRI selective serotonin reuptake inhibitors: paroxetine fluoxetine
• Naloxone: this reduces itch.
• Pregabapentin such as Lyrica.
• Antihistamines (medical dermatologists); reduces mast cell activity, thus itch
• Topicals (dermatologists); reduces itch. Calamine or menthol solution

A medical dermatologist is integral to exclude organic causes. Their role is to ensure that you do not have skin related issues that cause you to pick & scratch. In some cases, they may order specific blood tests, or even take skin biopsies for testing. Briefly, conditions that may cause itchy skin & picking include-

• Inflammatory: dermatitis, allergies, urticaria, LP
• Immunobullous- prebullous pemphigoid, LABD, DH
• Drugs- opiates, dexies, amphetamines, blunts, ganga, charlie, snow, blow & more
• Paraneoplastic- NHL, HL, occult malignancy
• Neurologica: Infarct, abnormal nervous system innervation, eg TTS, brachioradial, cervical rib compression
• Metabolic: renal, kidney, parathyroid abnormalities

Disclaimer: I am a procedural dermatologist, please consult my colleagues for investigation & management. The above is only an attenuated list of causes, your dermatologist will be aware of this list (& more).

I treat scars. My team & I are involved in the physical therapy side of things. We correct hyperpigmentation, hypopigmentation as well as depressed, picked out, atrophic scars secondary to excoriation & skin picking.

Our success rate is good, providing patients have insight. If you have active lesions, we will refer you to the medical team for management at the same time of scar revision.

I understand that you may feel embarrassed about this condition or would like to try DIY treatments. Here are some helpful hints that may help-

Social & emotional support. Involve your family & loved ones. They may give you better insight into things. If they reckon you need help, you probably do.

Get some hydrocolloid dressings or acne patches. Put them on new lesions or the ones that you are picking. They provide a moist wound environment & can reduce scarring.

Cognitive behaviour therapy & Habit Reversal Training can be conducted online, watch a YouTube video or ten. Practice & reinforce what you learn

Trim your nails- you will do less damage to your skin. Another extreme is to wear cotton gloves & have someone tape them with duct tape.

Seeing a specialist clinic for scar revision can markedly help your self-esteem. We perform laser treatments including fractional lasers, nano, pico lasers as well as microneedling & peels to help reverse scarring. 

My work is focused on the management of severe hypopigmented (white scars) & or really bad atrophic scars. I primarily use methods including skin surgery, melanocyte transfer & high-powered lasers. Most patients do not need to go down this route, my clinical team can assist & guide you.

If you are not inclined to fast & effective pharmacological management, & would like a more natural approach, see a naturopath. They can prescribe you some fairy dust as well as herbs. Some natural avenues include-

• Meditation
• Yoga
• Chanting
• Aromatherapy with essential oils
• Herbs to calm you down, camomile, St John’s wort, green tea etc…
• Diet (great if you have DH- gluten sensitivity)
• Acupuncture & pressure point
• Pseudo Medical desensitization
• Pyramid scheme ReDox water
• Stick needles in pressure point

If you think you have creepy crawly insects, worms, bugs, or crustaceans crawling under your skin, you may be imagining things.

In about 0.0001% of cases, you may be correct- cutaneous larva migrans, lice or scabies infestation. If in doubt bring a jar of what you catch to the public hospital dermatology department. They have a dearth of resources to investigate your catch.

Do not visit Cutis as we do not have the microscopes or knowledge to identify bugs & stuff. J

It is important to get help early as this can reduce both mental & physical scarring. Your emotional well-being is super important as skin picking disorder can have a massive impact on your family, work & social life. The fastest way to get help is to –

See a medical dermatologist to exclude organic conditions. During the consultation voice your viewpoints, including your desire to get psychological help. They will refer you to a psychologist. Most dermatologists will not prescribe psychotropic medication; however they may get a psychiatrist involved.

In Brisbane, our group works with Tammy White, psychologist, as well The OCD Clinic in Bulimba.

Disclaimer: I do not manage skin picking disorders / acne excoriee. Please book a consultation with my colleagues at Cutis.

If you ever consult me, you will notice my thumb nails & cuticles are pretty much fu*cked. I have a habit of picking the skin with my index finger. I also pick my scalp when I am anxious or frustrated. I know this occurs, & in many cases I cannot stop.

The flipside is that my habit does not cause scars & I am not socially bothered by my ragged cuticles or my bald patch from picking. This may apply to you, however if you are reading this, chances are you are bothered with skin picking.