Many of us consider skin picking an embarrassing, unhealthy habit, but if you struggle regularly with the urge to pick or control unconscious picking, it’s more likely a mental health condition. Dermatillomania (also called excoriation disorder) is more than just scratching now and again, and requires a strategy for treatment. From an expert-recommended approach to spots and scars to tackling triggers and getting help, this is your guide to skin picking.
Featured Experts
- Tina Alster, MD, is a board-certified dermatologist in Washington
- Jeanine Downie, MD, is a board-certified dermatologist in Montclair, NJ
- Brandi Roberts, MS, AMFT, is a psychotherapist at the OCD Center of Los Angeles
- Julia Harper, MD, is a board-certified dermatologist in Vestavia Hills, AL, and a Bubble Skincare partner
When Skin Picking Is More Than a Bad Habit
We’re all probably guilty of picking a pimple when we know we shouldn’t. But excoriation disorder is significantly more than that.
“Excoriation disorder is a type of disorder called body-focused repetitive behaviors (BFRBs),” explains psychotherapist at the OCD Center of Los Angeles, Brandi Roberts, MS, AMFT. “Other BFRBs include trichotillomania (hair pulling disorder), nail biting or picking, lip picking, teeth grinding or cheek biting. BFRBs are different from a bad habit because the thought-emotion-behavioral process involves the same cycle as obsessive-compulsive disorder (OCD), but instead of an obsession, they experience an urge to pick their skin.”
“One of the most common reasons that people pick at their face is because of acne,” explains Vestavia Hills, AL, dermatologist and Bubble Skincare partner, Julia Harper, MD. “They see, or feel a blemish, and they go to the mirror to squeeze, pop or just plain assault the pimple.”
The direct skin damage caused by picking often leads patients to seek out the guidance of a dermatologist. Washington D.C. dermatologist Tina Alster, MD, stresses that it’s vital to provide the right environment for these patients, one without shame.
“The result is repetitive picking of the skin that can lead to bleeding, sores and scarring,” Dr. Alster explains. “It’s critical to provide patients with a safe and accepting environment to discuss triggers as the first step to recognize the behavior and identify realistic ways to break the cycle.”
And breaking the cycle can be more difficult than kicking a bad habit.
Why ‘Stop Picking’ Doesn’t Work
“Typically, ‘don’t pick!’ does not work because the comment causes people to feel shame and frustration, which can trigger the urge to pick even more,” Roberts explains. “Stopping this behavior isn’t as simple as just stopping because many times it’s an unconscious behavior. The path towards decreasing this behavior takes time, intentionality and compassion as they take small steps towards change. Individuals with skin picking disorder would love to ‘just stop,’ and they would if they could.”
And getting guidance on that path can help break the cycle.
“If patients aren’t already under the care of a mental health professional, I often recommend that they seek consultation with one who can provide cognitive behavioral therapy (CBT) and/or habit reversal training,” says Dr. Alster.
“CBT is a modality which focuses on identifying how thoughts and feelings lead to behaviors,” Roberts says. “When we change the way we think, we then change the way we feel and behave, and when we change our behaviors, we affect how we think and feel.”
Learn more about CBT here.
Treating Skin Picking
If you’ve recently picked your skin, Dr. Alster recommends treatment to speed up the healing process. “Application of a mild hydrocortisone cream to reduce inflammation and the potential for scarring is my initial approach,” she says. “Covering open wounds with a hydrocolloid bandage speeds healing and provides a physical barrier that protects injured skin from additional manipulation and picking.”
“When skin picking is more extensive, they often need prescription or oral antihistamines like doxepin,” explains Montclair, NJ dermatologist Jeanine Downie, MD. “I always recommend tons of moisturizer, and they may need biologic prescription medications to decrease their urge to itch and sometimes psychiatric counseling.” Additionally, it’s vital to keep skin protected going forward. “Sunblock is always a must with these patients,” Dr. Downie adds.
And remember, you don’t have to “air dry” a picked spot.
“If spots are super crusty, a tiny amount of petrolatum or a healing ointment can help at bedtime,” says Dr. Harper. “And if you don’t mind a bandage, covering them is a good idea too. They really don’t need to ‘breathe’ or ‘air dry.’ Restoring the disrupted barrier with a moisturizer is also a good idea. I like Bubble Cloud Surf ($16) for acne patients, and yes, you can use it right over those picked-at spots too.”
For scars that have already formed, Dr. Alster recommends laser treatments. “Providing pulsed dye (or V-Beam) laser treatment reduces wound redness and promotes wound healing,” she says. “Scars can be effectively reduced with laser scar revision by a physician who specializes in wound and scar management.”
Treating Excoriation Disorder
Alongside CBT, Roberts notes that skin picking needs a lot of compassion. “Throughout treatment, it is also important for individuals to utilize mindfulness and self-compassion because many times the shame and embarrassment can become a barrier to treatment,” she explains. “Mindfulness involves becoming more aware of emotions and behaviors because it is difficult to change things we are not aware of. Self-compassion helps quiet the internal self-criticism during the treatment process.”
You can also help lessen feelings of isolation and embarrassment by seeking group therapy focused on BFRBs.
“Triggers for skin picking differ from person to person,” Roberts explains. “But typically, the triggers fall into these categories: sensations, thoughts, emotions, body position and environment. Some people might feel the urge to pick because of the sensation of rough or broken skin, and when they feel the texture, it leads to picking. The urge to pick might show up due to emotions, like anxiety, excitement or even boredom.”
No matter what your triggers are, understanding them is often the first step in treatment.
Resources
- Picking Me Foundation: a Chicago-based nonprofit focused on community support and education for skin picking and body-focused repetitive behaviors (BFRB).
- TLC Foundation: for more than 30 years, the TLC Foundation has provided support for BFRB disorders, including a nationwide directory of medical, therapeutic and self-led care as well as peer-led support groups.
- OCD Center of Los Angeles: a private treatment center specializing in individual and group therapy (both in-person and online) for the treatment of OCD and related conditions.
