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Skin-Picking Disorder

(Excoriation Disorder)

By Katharine A. Phillips, MD, Assistant Professor of Psychiatry, Weill Cornell Medical College; Assistant Attending Psychiatrist, New York-Presbyterian Hospital
Dan J. Stein, MD, PhD, Professor and Chair, Department of Psychiatry, University of Cape Town

In skin-picking disorder, people repeatedly pick at their skin, damaging it.

Skin-picking disorder is a type of obsessive-compulsive and related disorder (see Obsessive-Compulsive Disorder (OCD)). People with the disorder compulsively pick at or scratch their skin. They do not do it to remove a spot that they think is unattractive (as people with body dysmorphic disorder do—see Body Dysmorphic Disorder). Some people pick at healthy skin. Others pick at calluses, pimples, or scabs.

Skin picking often begins during adolescence, although it may begin at other ages. About 1 to 2% of people have the disorder. About 75% of them are female.


The methods and areas people pick at vary from person to person. Some people have many sores or scarred areas. Others people have only a few scars or sores. The areas people pick at may change over time.

Some people pick at their skin somewhat automatically, without thinking about it. Others are more conscious of the activity.

People do not pick at their skin because they are concerned about their appearance. However, they may feel tense or anxious just before they do it, and skin picking may relieve that feeling. Afterward, they often feel gratified.

Many activities (rituals) may accompany skin picking. People may painstakingly search for a particular kind of scab to pick at. They may pull the scab off in a particular way—for example, using their fingers or an implement. They may bite or swallow the scab once it is pulled off. Most affected people also repeatedly pull out their hair, bite their nails, chew their cheek, or do other repetitive body-focused activities. Some people pick at the skin of others.

People may feel embarrassed by or ashamed of the way they look. Consequently, they may avoid situations in which others may see the skin damage. They typically do not pick in front of others, except for family members. Many people try to camouflage the skin damage with clothing or make-up. People may also be distressed by their loss of control and repeatedly try to stop picking at their skin.

Symptoms typically vary in intensity but may continue throughout life.


Doctors diagnose skin-picking disorder based on symptoms:

  • Picking at skin so much that it damages the skin

  • Repeatedly trying to stop picking

  • Feeling greatly distressed or becoming less able to function because of the activity


Treatment with serotonin reuptake inhibitors (a type of antidepressant—see Table: Drugs Used to Treat Depression) may help.

Cognitive-behavioral therapy—in particular, habit reversal therapy that specifically focuses on this disorder—may also lessen symptoms. For habit reversal therapy, people are taught to become more aware of what they are doing and to identify situations that trigger the activity. They are also taught strategies to help them stop themselves from picking at their skin—for example, by substituting a different activity for skin picking.