Merck Manual

Please confirm that you are not located inside the Russian Federation

honeypot link

Skin-Picking (Excoriation) Disorder

By

Katharine A. Phillips

, MD, Weill Cornell Medical College;


Dan J. Stein

, MD, PhD, University of Cape Town

Last full review/revision Jun 2021| Content last modified Jun 2021
Click here for the Professional Version

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

  • People with skin-picking disorder may feel tense or anxious just before they do it, and skin picking may relieve that feeling.

  • Doctors diagnose the disorder when people pick at the skin enough to damage it, try to stop picking at their skin and cannot, and are significantly distressed by their behavior or function less well because of it.

  • Cognitive-behavioral therapy that specifically focuses on skin-picking disorder and certain antidepressants or N-acetylcysteine may help lessen symptoms.

People with the disorder repeatedly pick at or scratch their skin. They do not do it to remove a spot or blemish that they think is unattractive (as people with body dysmorphic disorder Body Dysmorphic Disorder In body dysmorphic disorder, a preoccupation with one or more nonexistent or slight defects in appearance results in significant distress and/or impairs functioning. People typically spend hours... read more do) or diseased. 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.

Symptoms

The methods and areas people pick at vary from person to person. Some people have many sores or scarred areas. Other 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 (which may be a symptom of body dysmorphic disorder Body Dysmorphic Disorder In body dysmorphic disorder, a preoccupation with one or more nonexistent or slight defects in appearance results in significant distress and/or impairs functioning. People typically spend hours... read more ). However, they may feel tense or anxious just before they do it, and skin picking may relieve that feeling. Afterward, they often feel a sense of gratification.

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 such as tweezers. They may bite or swallow the scab once it is pulled off.

People may feel embarrassed by or ashamed of the way they look or of their inability to control their behavior. 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 or reduce picking at their skin, but they cannot.

Symptoms typically vary in intensity but may continue throughout life.

Diagnosis

  • A doctor's evaluation, based on specific diagnostic criteria

Doctors diagnose skin-picking disorder based on symptoms:

  • Picking at skin so much that it damages the skin

  • Repeatedly trying to decrease or stop picking

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

Treatment

  • Drugs

  • Cognitive-behavioral therapy

Cognitive-behavioral therapy Psychotherapy Extraordinary advances have been made in the treatment of mental illness. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Most treatment... read more —in particular, habit reversal therapy that specifically focuses on skin-picking disorder—may also lessen symptoms. For habit reversal therapy, people are taught to do the following:

  • Become more aware of what they are doing

  • Identify situations that trigger the activity

  • Use strategies to help them stop themselves from picking at their skin—for example, by substituting a different activity (such as clenching their fist, knitting, or sitting on their hands) for skin picking

Drugs Mentioned In This Article

Generic Name Select Brand Names
ACETADOTE
NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
Others also read

Test your knowledge

Panic Attacks and Panic Disorder
A panic attack is a brief period of extreme distress, anxiety, or fear that begins suddenly and is accompanied by physical and/or emotional symptoms. Panic attacks are experienced by at least which percentage of American adults during any given year? 
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
TOP