To pick or not to pick? Insights into skin picking

What is skin picking?

Skin picking, also known as dermatotillomania, excoriation disorder or skin picking disorder, is a body-focused repetitive behaviour that occurs when a person cannot stop picking their skin. Skin picking disorder tends to affect females more than males. It is clinically classified under Obsessive Compulsive and Related Disorders. Commonly affected areas are the face and arms, but almost any area of skin can be picked (e.g. legs, intimate areas). Although skin picking for most is done using the hands/fingernails, people can use other instruments, for example tweezers. The time spent engaging in skin picking can vary, sometimes it can last for hours.

Why do people do it?

There are several reasons why people become engaged in this repetitive and often damaging behaviour:

• Underlying dermatological disorder – conditions such as acne or eczema can promote picking in response to a lesion (e.g. a spot or scab), or symptom (e.g. itch). Treatment of the underlying condition coupled with appropriate psychological interventions can lead to reduction or cessation of picking.
• Emotional picking – people tend to pick their skin in response to psychological states such as stress, anxiety, or anger. Recognising these triggers is important when trying to break the skin picking cycle.
• Habitual picking – some people engage in skin picking as a habit. This occurs in a state of boredom, or when idle or feeling tired.
• Obsessive-compulsive disorder – skin picking comes under the umbrella of obsessive-compulsive behaviours. I ask all my skin picking patients if they have other associated behaviours (e.g. frequent handwashing, hair pulling or plucking, ritualistic behaviours, excessive tidying), as skin picking can be a sign of further undiagnosed problems that can benefit from treatment.

What other problems can skin picking cause?

Infection – Our skin is already colonized with bacteria, so breaking the natural barrier through picking can allow surface or other harmful bacteria to enter. This causes inflammation, bleeding and pain. In extreme cases, infection can manifest as collections of pus, and cause other problems like fever, especially if bacteria enter the bloodstream. I usually treat skin infections with antibiotics, in addition to advising good skincare with antimicrobial washes and emollients.

Changes in pigmentation – frequent picking and an ongoing reparative response by the skin to inflammation or infection can result in pigmentary changes. Skin in picked areas can become lighter or darker than your normal skin tone.

Scarring or disfigurement – scarring as a consequence of long-term skin picking or physical disfigurement (e.g. picking a hole in the skin to cause an ulcer) are other more extreme but possible consequences I have encountered.

Nail changes – skin pickers can develop nail deformities as they typically use their fingers/fingernails to pick or cause repetitive damage to the cuticle. These can manifest as horizontal ridges in the nails.

Psychological distress – skin picking is a behaviour associated in some cases with emotional distress, mood or anxiety problems. People may be feeling embarrassed and socially isolate themselves as a consequence, or spend excessive time disguising their problem (e.g. with clothes or makeup). If these problems are detected I usually discuss additional treatment (e.g. psychological interventions).

How can I overcome skin picking?

Recognising triggers is important when trying to break the skin picking cycle. I suggest noting when or where you commonly pick. A daily journal to write down any thoughts/feelings/situations that promote picking (you can write these down in a notebook or even on your mobile phone/tablet etc.) can be very useful. Thoughts, feelings, or situations that promote picking can then be identified and dealt with. This can be difficult to do on your own, it may be helpful to enlist someone you trust to support you or seek the advice of a healthcare professional.

Tips for overcoming skin picking include:

• If a skin condition is predisposing you to pick, for example acne, I advise that you seek appropriate medical treatment as a first option
• Covering hands/fingers where possible, especially if these are what you use to pick
• Keep natural nails short if you use them to pick. If you pick using fingernails, false nails may be a deterrent (as you are less likely to want to damage them by picking).
• Keep your hands busy rather than picking, for example, squeezing a stress ball, clenching and unclenching hands, moisturising or massaging. This less harmful behaviour can over time replace skin picking
• When you get the urge to pick moisturise your hands for a minute instead of picking, or clench your hands into fists for 15 seconds and then release
• Try to resist picking each time you feel the urge, start by resisting for 1 minute then slowly increase by a minute at a time
• If you have someone you can trust at work or at home, then ask them to tell you if they see you picking so you are made aware and more likely to stop
• If you use an instrument to pick, make this as inaccessible as possible
• If you must pick, only allow yourself to do so for a set amount of time, make sure you clean your hands/instruments effectively and take care of your skin afterwards to avoid long-term damage
• Formal cognitive behavioural therapy can be useful to break the skin picking cycle, this is usually accessible through a clinical psychologist or psychodermatologist (e.g. habit reversal therapy)
• Some people with skin picking require oral medication to treat this problem in conjunction with psychological interventions. A psychodermatologist may be able to help.
• Other resources include :
  • • • StopPicking.com (paid online programme designed to help people stop picking),
      • Headspace (this is an app that is designed to teach users how to use mindfulness and other relaxation techniques. It does not specifically target picking, but may help manage stressful thoughts)

 

Helpful resources

1. https://www.bfrb.org/index.php – for more information on body focused repetitive behaviours
2. If you are suffering from persistent negative thoughts, or feel like you need to talk to someone straight away about the way that you are feeling, then you might like to get in contact with Mind, Samaritans or Changing Faces, who may be able to help.

Mind

For better mental health

0300 123 3393

Samaritans

Talk to us

08457 909 090

Changing faces

Support Information & Advice

0300 012 0275

 

References

Excoriation Disorder (skin picking disorder)