Skin Picking Disorder

  • Best ResultsVariable
  • Treatment RecoveryVariable
  • Procedure TimeVariable
  • Skin SpecialistDermatologist, psychiatrist
  • Duration of ResultsCan be permanent
  • AnaestheticVariable
  • Back to WorkVariable
  • Cost$-$$

Skin Picking Disorder

Skin picking disorder is also known as dermatillomania. This is a common condition that affects 5% of the population. Depression, stress & anxiety are predisposing factors. This is a form of obsessive-compulsive disorder. Skin scars are a frequent sequela of skin picking. If you are serious about treatment, a team consisting of medical dermatologists, psychiatrist & psychologist can help you.

FactsFacts on skin picking disorder or dermatillomania

  • This is a form of obsessive-compulsive disorder 
  • Patients have an uncontrollable urge to pick
  • Dermatillomania is a disorder of exclusion
  • Treatments include cognitive behaviour therapy & SSRIs
  • Anti-anxiety drugs can reduce the urge to pick
  • Skin picking can lead to scars
  • Skin scars are best treated when this condition is in complete remission
  • Hypopigmented scars are treated with lasers, surgery & pigment stimulators
  • Most cases require a team of dermatologists, psychiatrists & psychologists

What are the symptoms of skin picking disorder or dermatillomania?

Dermatillomania is also known as skin picking disorder, obsessive skin picking, or neurotic excoriations. The predominant symptom is the urge to pick skin on the face, trunk and limbs. Nail picking, cuticle picking, & hair plucking are also examples of dermatillomania.

Most patients are anxious or stressed. Picking provides relief & satisfaction. In most cases patients are unaware of their actions as it is often an unconscious behaviour.

How is skin picking disorder / dermatillomania classified medically?

This is a true medical condition that has been defined as a psychiatric disorder under DSM-5. This is a form of obsessive-compulsive disorder,

In order to receive a diagnosis in this category, the person must:

  • Experience some of the symptoms listed above (picking)
  • Be under clinical distress or impairment
  • Have symptoms that are not caused by a medical, substance or dermatological condition
  • Have symptoms that cannot be explained by another psychiatric disorder

In order for an accurate diagnosis to be made, help from a medical professional should be sought. If you are serious about getting help, the three professions that should be involved include a medical dermatologist, psychiatrist & psychologist. 

Disclaimer: I am a procedural dermatologist, namely my job is to fix up scarring post dermatillomania. My medical colleagues at Clinic Cutis can assist in your treatment.

How common is it?

Very. Reports of up to 5% of the population, hence 1 in 20. This is more common for females & people with higher anxiety levels.

I personally had two forms of dermatillomania, namely trichotillomania, hair pulling as well as cuticle picking. I still have the latter.

(Even though I have some insight regarding this condition, I do not treat obsessive skin picking. This is best treated by a medical dermatologist. My work is entirely procedural.)

What is the difference between picking acne & true skin pickers/ dermatillomania?

Picking acne is known as acne excoriee or picking acne. Unlike true skin picking associated with dermatillomania (where there is no primary pathology), there is a substrate for acne pickers. The outcome for picking acne is excellent if acne lesions are treated effectively. A medical dermatologist can discuss effective ways to stop acne lesions from recurring, and hence cure acne excoriee.

Davin’s viewpoint on treating scars for dermatillomania

This is a common condition. It is also known as neurotic excoriations, obsessive picking, or skin picking disorder. Trichotillomania is another example of picking. Acne excoriee is frequently referenced as part of this disorder of obsessive compulsion, however this is incorrect. With acne there is a substrate to pick. When acne is treated, picking stops. Picking acne heralds a better prognosis compared to dermatillomania, providing patients have insight.

Skin picking disorder can be successfully treated if patients want to be treated. Early & effective treatment will mitigate skin scars. People who don’t accept their condition or have little or no insight will be left with marked, extensive scars that can be difficult to treat. The trifecta of management is via a medical dermatologist (not me), psychologist & psychiatrist. A dermatologist is required to exclude organic causes including metabolic, immunobullous, endocrine, paraneoplastic & inflammatory causes. In some cases tests are required, including special skin biopsies.

A psychiatrist can prescribe SSRI medications to help reduce obsessive compulsive disorders & anxiety. A psychologist can teach distracting techniques including CBT. Other helpful methods of relaxation include meditation, yoga, acupuncture & fuzzy stuff like aromatherapy. Remember, the greatest predictor of skin scarring is the time taken to effective control. I do encourage patients to seek early help.

Disclaimer: I am a procedural dermatologist. I do not treat skin picking disorder. This is a medical condition that requires close follow up. My work is focused on surgical treatments. If you have active picking, my colleagues at Clinic Cutis can assist in providing you a diagnosis & referring you to a team of psychologist & if required, psychiatrist for medications.

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