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Skin-Picking (Excoriation) Disorder


Katharine A. Phillips

, MD, Weill Cornell Medical College;

Dan J. Stein

, MD, PhD, University of Cape Town

Last full review/revision Sep 2018| Content last modified Sep 2018
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.

Skin-picking disorder is a type of obsessive-compulsive disorder. 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). 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 of Skin-Picking Disorder

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

Most people with skin-picking disorder 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 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 picking at their skin.

People with skin-picking disorder typically try to stop picking their skin or to do it less often, but they cannot.

If done excessively, skin picking can cause scarring, infections, excessive bleeding, and even a serious infection of the bloodstream (septicemia).

Many people with skin-picking disorder also have other mental health disorders, such as obsessive-compulsive disorder, hair-pulling disorder, and depression.

Symptoms typically vary in intensity but may continue throughout life.

Diagnosis of Skin-Picking Disorder

  • 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 of Skin-Picking Disorder

  • Drugs

  • Cognitive-behavioral therapy

Treatment with selective serotonin reuptake inhibitors (a type of antidepressant) or N-acetylcysteine may help.

Cognitive-behavioral therapy—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

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