dermatillomania

Dermatillomania, also known as excoriation disorder, is a condition defined by repetitive picking of the skin, leading to tissue damage, ulcers, and scarring. It is classified as a body-focused repetitive behavior and is included in the DSM-5-TR under obsessive-compulsive and related disorders as excoriation disorder.

People with dermatillomania commonly experience pre-picking tension or arousal that is relieved by picking. The skin most often targeted includes the face, arms, hands, and lips, but any exposed area can be involved. Behavior may be accompanied by rituals, and attempts to resist the urge frequently fail or cause distress.

Onset is usually in adolescence or early adulthood. The course is typically chronic with waxing and waning severity. Prevalence estimates in the general population range from about 1 to 5 percent, and the condition is more frequently observed among individuals with obsessive-compulsive spectrum disorders and other body-focused repetitive behaviors.

Etiology is multifactorial, involving genetic vulnerability, neurobiological factors affecting impulse control and sensation processing, emotional regulation difficulties, and environmental stress. Sensory triggers and tactile relief play roles for some individuals, while comorbid anxiety, depression, and other OCD-related symptoms are common.

Diagnosis relies on clinical evaluation and history; other dermatologic conditions, substance use, or medical illnesses that explain skin lesions must be excluded. It is important to differentiate from dermatillomania-like behaviors due to skin disorders or mania or psychosis, and from trichotillomania when hair is primarily involved.

Treatment generally combines psychotherapy and, when appropriate, medication. Habit reversal training with awareness and competing response strategies, cognitive-behavioral therapy including exposure and response prevention, and dialectical behavior therapy are used. Selective serotonin reuptake inhibitors and other antidepressants may help with comorbid anxiety or mood symptoms; N-acetylcysteine has mixed efficacy data. Skin care and barrier strategies can support symptom management.