Dermatillomania (Skin Picking)

What is dermatillomania?

Dermatillomania is a mental health condition where a person compulsively picks or scratches their skin, causing injuries or scarring. Also known as excoriation disorder or skin-picking disorder, this condition falls under the category of obsessive-compulsive disorders (OCDs). When it leads to significant scarring and injuries, this condition can severely affect a person’s mental health, well-being and quality of life.

This condition (pronounced derm-ah-till-oh-main-ee-ah) gets its name from three Greek words:

• Derma: skin.
• Tillo: pulling (or picking).
• Mania: excessive behavior or activity.

What is the difference between dermatillomania and obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a specific condition that also lends its name to a category of mental health conditions. While dermatillomania falls under the overall category of obsessive-compulsive disorders, it still has some key differences from the specific condition of OCD.

• Obsessions. OCD involves obsessions, which are thoughts or urges that a person can’t control and doesn’t want. Those kinds of obsessions don’t happen with dermatillomania.
• Feeling of reward. When people with dermatillomania pick at their own skin, they often feel relief or other positive emotions. That doesn’t happen with OCD.
• Damage. OCD rarely involves any kind of self-damage or self-injury. With dermatillomania, that kind of self-injury is extremely common.

Who does it affect?

In years past, experts believed this condition was much more common in women. However, recent research shows that only about 55% of people with this condition are women. Women are also more likely to seek treatment for this problem.

The condition usually starts during puberty but can happen at any age. The condition is also more likely to happen to people who have “triggering” conditions like acne or eczema.

How common is this condition?

Dermatillomania is an uncommon condition, with an estimated 2% of people having it at any time and up to 5.4% of people having this condition at some point in their life.

How does this condition affect my body?

Dermatillomania causes a person to pick at their skin compulsively. For some people, picking is an automatic movement, and they might not even realize they’re doing it. Others are aware that they’re doing it but can’t stop themselves.

For some people, picking focuses on areas of skin that are rough or already have some kind of blemish or irregularity. Examples include picking at pimples, patches of dry skin or scabbed-over cuts and scratches (those wounds can come from picking or from other causes).

Picking can create new wounds or reopen old ones, leading to bleeding and scarring. When this condition is severe, it can lead to skin damage that’s extensive enough that it may need surgery, such as skin grafting, to repair the damage. Infected wounds may also need antibiotic treatment.

In rare cases, infections from these wounds can spread throughout your body, leading to an overwhelming immune system overreaction. That overreaction, a condition called sepsis, is a life-threatening medical emergency.

Mental health effects

Often, people with this condition feel embarrassed or ashamed of the visible injuries, trying to hide them with clothing, makeup or other means. Because of that, this condition can be a source of anxiety, depression or social isolation. This condition can also affect people’s work or social lives.

What are the symptoms of dermatillomania?

The main symptom of dermatillomania is compulsively — meaning, the impulse or urge is impossible or incredibly difficult to resist — picking at your skin. Experts also describe the act of skin-picking using the following words:

• Scratching.
• Digging.
• Squeezing.
• Rubbing.

Picking usually involves fingernails and fingertips but can also include biting with your teeth (especially when the skin surface affected is on your lips. It can also involve sharp items like tweezers or pins.

Types of picking

This activity usually happens in one of two ways, “automatic” or “focused.”

• Automatic: This kind of picking often happens without a person thinking about it. Experts sometimes call this “scanning” because it tends to involve running hands or fingertips across areas of skin to find any areas that feel different, which might then become an area for focused picking.
• Focused: This kind of picking is “focused” on a specific area, and the picking can go on for hours. This kind of picking tends to be more severe and is more likely to cause damage to your skin.

Where it happens on your body

Picking tends to focus on certain areas of your body. Those areas are the ones that you can most easily reach with your hands, including:

• Head: Face, scalp and neck.
• Arms: Fingers, hands and forearms.
• Legs: Thighs, calves, feet and toes.

What causes the condition?

There aren’t any confirmed causes of dermatillomania, but experts suspect a few different factors might play a role, including:

• Genetics. People with dermatillomania are much more likely to have at least one first-degree family member (meaning, a parent, a sibling or a child) who also has this condition.
• Changes in brain structure. People with dermatillomania are more likely to have some key differences in the structure of brain areas that control how they learn and form habits.
• Stress, anxiety or other conditions. Dermatillomania might be a coping mechanism for other issues or mental health conditions. It might also be related to boredom or other issues.

Other conditions that happen with dermatillomania

People with dermatillomania are more likely to have other mental health or medical conditions. Some of these include:

• OCD or other OCD-related disorders like hair-pulling (trichotillomania) or nail-biting (onychophagia).
• Depression.
• Anxiety disorders.
• Bipolar disorder.
• Prader-Willi syndrome.

Is it contagious?

Dermatillomania isn’t contagious and can’t spread from person to person.

How is it diagnosed?

Diagnosing dermatillomania involves a combination of a physical exam, where your healthcare provider looks for signs of this condition on your body. They’ll also ask you questions about your medical history, your life circumstances and any behaviors that might relate to this condition. Diagnostic and lab tests can help rule out other causes for skin picking but are rarely needed to confirm this diagnosis.

Diagnosing this condition requires meeting all five of the following criteria:

1. Skin picking that’s ongoing or happens repeatedly.
2. Multiple attempts to stop skin picking or to do it less often.
3. Negative impact on various aspects of your life, including your work or social life, because of shame, embarrassment or other similar emotions.
4. Skin picking behavior doesn’t happen because of any other medical condition, such as scabies or other skin-related conditions, or because of a drug (recreational or prescription).
5. The skin picking behavior isn’t because of another mental health condition, such as body dysmorphic disorder, where you pick at your skin because you believe you have a problem with your appearance and you pick at your skin to try to fix that.

What tests will be done to diagnose this condition?

Medical tests that are used with this condition are almost always to rule out any other medical conditions. Your healthcare provider can best explain what tests they’d like to run for your specific case and why.

How is dermatillomania treated, and is there a cure?

Treating dermatillomania usually involves a combination of medication and therapy. Research shows that combining the two tends to help more than just one type of treatment alone.

Medications

The most common medications that healthcare providers prescribe to help treat this condition include:

• Antidepressants. The most likely medications for this are selective serotonin reuptake inhibitors (SSRIs).
• Anticonvulsants. Lamotrigine is a medication that helps with uncontrollable muscle movements. Research shows it can help in some cases of dermatillomania.
• Antipsychotics. These medications help by modifying the balance in your brain chemistry. These medications commonly treat many conditions like dementia, bipolar disorder and schizophrenia. Researchers are also continuing to look into how they can help treat conditions like dermatillomania.
• Nutraceuticals. These are nutrition-related products that can also affect medical or mental health conditions. For dermatillomania, research has found that the amino acid supplement N-acetylcysteine can help reduce the urge to pick.

Therapies

Psychotherapy can help treat this condition in various ways, depending on the therapy method used.

• Habit reversal therapy. This method involves helping you become more aware of your behaviors and activity patterns. By helping you become more aware, this therapy teaches you to break habits like skin picking.
• Group therapy and peer support. People with dermatillomania may benefit from specific types of group therapy or support.
• Cognitive behavioral therapy (CBT). This method involves teaching coping mechanisms and strategies to help change behavior.
• Acceptance and commitment therapy. This therapy method helps people change behaviors like skin picking by accepting negative feelings that fuel the behavior. Mindfulness and other positive coping mechanisms also play a role.

Other treatments related to dermatillomania

People with severe damage to their skin or their tissue underneath may need additional medical treatment and care. Your healthcare provider is the best person to explain the treatments they recommend, which might include surgery and skin grafting, antibiotics and more.

Complications/side effects of the treatment

The possible side effects and complications depend on the circumstances, the severity of your condition and other factors. Your healthcare provider is the best source of information about what you should expect or watch for because they can tailor the information to your specific case.

How do I take care of myself and manage symptoms?

Dermatillomania isn’t something you should self-diagnose. A trained, experienced mental health provider should be the one to determine if you have dermatillomania or if it’s actually another condition. It also isn’t something you should treat on your own, partly because medication, therapy methods and other types of care need a prescription or other input from a healthcare provider.

How soon after treatment will I feel better?

Your healthcare provider can tell you more about what you can expect as you undergo treatment and what you can do to help yourself through that process. This is because the recovery time and how long it will take you to feel better depend on many different factors, and your healthcare provider can take all those factors into account when they tell you what to expect.

How can I reduce my risk or prevent this condition?

Dermatillomania is a mental health condition, but experts still don’t fully understand what causes it. That means it happens unpredictably and it isn’t preventable. There isn’t a known way to reduce your risk of developing it either.

What can I expect if I have this condition?

Dermatillomania usually isn’t a dangerous condition unless it's very severe. The main risk from this condition is from open wounds, which might develop infections because of repeated picking or damage. Though this condition isn’t usually dangerous directly, it still commonly has severe negative effects on your quality of life and overall sense of well-being.

People with dermatillomania often feel ashamed or embarrassed, which is why so many people with this condition avoid treatment. Avoiding or delaying treatment increases the risk of having permanent issues like scarring and further mental health problems.

How long does dermatillomania last?

Dermatillomania is a life-long condition because of the risk of relapse. However, people with this condition can go into remission — meaning, they no longer feel the urge to pick their skin or can avoid doing it for long periods, if not indefinitely.

What’s the outlook for this condition?

The outlook for the condition depends on how severe it is and other factors. Most people with this condition don’t suffer physically dangerous effects. But without treatment, most people with this condition will struggle with mental health effects like anxiety, shame or embarrassment.

How do I take care of myself?

If you have dermatillomania, it’s important to see a healthcare provider (or multiple providers, depending on your specific needs) with training and experience in treating this disorder. They can give you the best guidance on caring for yourself and what you can do to improve your outcome.

In general, you should do:

• Be honest about your condition. Dermatillomania is a mental health condition that affects your mind and behaviors. Just as you’d see a healthcare provider for an ear infection or a heart problem, you should also see a healthcare provider for mental health conditions like dermatillomania. They can help treat the effects of your condition, physical and mental alike.
• See your healthcare provider(s) as recommended. This is especially important for therapy sessions, mental health visits and any other care you might need.
• Take medication if prescribed. Medications can make a big difference in helping you avoid acting on any urges to pick at your skin.
• Avoid triggers when possible. People with dermatillomania often pick at their skin in certain settings or situations. Avoiding those triggers can make a big difference.
• Take away the opportunity to pick. People with dermatillomania may benefit from fidget devices or other things that can help them avoid picking behaviors by keeping their hands occupied. Other ways to avoid picking include wearing gloves or clothing that keep you from picking at your skin.

When should I go to the ER?

People with dermatillomania usually don’t need emergency medical care unless they have severe injuries because of this condition. You should seek care in cases with severe bleeding or signs of infection. The signs of infection, including dangerous conditions like sepsis, include:

• Swelling, redness or other color changes around the injury.
• Fast heart rate or breathing.
• Fever or chills.
• Confusion or delirium.
• Dizziness or passing out from low blood pressure.

A note from Cleveland Clinic

Dermatillomania is a mental health condition that can severely affect your life due to feelings of shame, embarrassment or guilt. These feelings are common, and seeing a healthcare provider can help you overcome them and receive treatment for this condition. Healthcare providers have special training and experience in treating conditions and their effects, and helping you feel comfortable with getting the treatment you need. With treatment, many people can overcome or manage this condition. That means you can focus on what you want to do in life rather than worrying about what people might notice or think about you.