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Excoriation Disorder: When You Can’t Stop Picking at Your Skin

Once in a while, you might pull at a hangnail or pick at a scab. But some people pick at their skin repeatedly and constantly. The irritation damages their skin and can lead to sores and scars. They’re distressed, but they can’t seem to stop. They may have trouble tackling their everyday activities.

This condition is called excoriation disorder, and it’s also known as dermatillomania, psychogenic excoriation, or neurotic excoriation. It’s considered a type of obsessive compulsive disorder.

“Skin-picking is quite common,” said Divya Singh, MD, a psychiatrist at Banner Behavioral Health Hospital in Scottdale, AZ.

The condition is relatively rare and typically begins around the start of puberty. It’s more common in females than males, and people with skin-picking disorder often have skin conditions like acne or eczema.

It sometimes starts with a small scab or rash and picking at it means it never heals. Or it could start with picking at the skin around the nails as a way to relieve stress. For some people it’s a nervous habit. Others are trying to remove a perceived skin flaw. It can come and go over time.

Excoriation disorder is linked with other mental health problems

People with excoriation disorder can spend a lot of time picking their skin, and then spend even more time covering up the damaged spots. “This can add up to several hours a day in severe cases,” Dr. Singh said. So, they might miss or be late for work, school, and social events.

They may feel embarrassed, avoid situations where people might notice their damaged skin, and lose productivity. They can suffer from shame, anxiety, and depression. Excoriation disorder is considered a body-focused repetitive behavior (BFRB) and people with it may also have other behavior disorders, such as:

People with excoriation disorder can also face medical problems—infections, lesions, scarring, and even disfigurement in some cases.

Treatment can help people with excoriation disorder

Mild cases of excoriation disorder might not need treatment. But people who spend a lot of time picking their skin, are developing scars, are upset about picking their skin, or find that skin-picking impacts their social life could benefit from expert care.

Treatment for excoriation disorder starts with a comprehensive psychiatric examination. Behavioral therapy can help people learn what triggers their skin picking and find an alternate activity, like playing with a fidget toy. Wearing gloves or Band-Aids can also help.

Medication such as Prozac, anticonvulsants, some supplements, and the opioid-blocking drug naltrexone might also alleviate the behavior.

Obsessive nail-biting and self-harm can be seen as similar conditions, but it’s important to understand exactly what you are dealing with. If you or a loved one might have excoriation disorder, behavioral health experts can help. Find a doctor near you.

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