skinpicking

Skinpicking, also known as dermatillomania or excoriation disorder, is characterized by repetitive picking of the skin that leads to tissue damage. It is classified in the DSM-5-TR as an obsessive-compulsive and related disorder.

People may pick at perceived skin imperfections or scabs, often in response to tension or anxiety, and may do so in private. Repetitive picking can cause lesions, bleeding, scarring, and infections, and can interfere with daily functioning. Common sites include the face, arms, hands, shoulders, and back.

Causes are multifactorial, involving genetic vulnerability, brain circuits related to impulse control and habit formation, and environmental stress. Skinpicking frequently co-occurs with anxiety disorders, depression, obsessive-compulsive disorder, ADHD, and autism spectrum conditions. Triggers can include sensory sensitivity, perfectionism, boredom, or stress.

Diagnosis is typically clinical, based on history and observed skin damage, with attention to exclusion of other medical conditions or substance effects. Diagnostic criteria emphasize recurrent skin picking with at least some attempts to stop, causing distress or impairment, and not better explained by another condition or substance.

Treatment focuses on reducing symptoms and improving quality of life. Evidence supports cognitive-behavioral therapy, particularly habit reversal training and exposure and response prevention. Other approaches include acceptance and commitment therapy, mindfulness, and treatment of co-occurring conditions. Pharmacotherapy such as selective serotonin reuptake inhibitors may help some individuals; there is mixed evidence for N-acetylcysteine. Practical strategies include skin care, barrier protection, using gloves or fidget tools, and stress management.

Prognosis varies; some achieve significant improvement with treatment, while others experience chronic symptoms. Early intervention and addressing comorbid conditions can improve outcomes.