Dermatillo- mania
dr · muh · tuh · luh · may · nee · uhA complex psychological condition that manifests in the urge to pick the skin to the point of bleeding.
What Is Dermatillomania?
Dermatillomania is a complex psychological condition that manifests in compulsive skin picking to the point of bleeding. It’s officially called “excoriation disorder” by the American Psychiatric Association and it falls under the OCD umbrella. But in everyday conversation, most people call it skin picking or dermatillomania. And the truth is, most people with dermatillomania don’t even know that they have it because the skin picking so often occurs in private and it’s largely under-covered in the media.
People with dermatillomania typically use their fingernails to pick at small areas of skin all over the body, from the face to the arms, even the soles of the feet, until they feel satisfied. (Some may bite the skin, or use tweezers or other tools.) They usually pick the skin out of an almost uncontrollable urge to do so, sometimes triggered by a bump or a pimple, or during a moment of stress or boredom. Online, people with dermatillomania have shared artwork that depicts how the condition feels with photographs of skin covered in peeling paint.
Dermatillomania is considered a body-focused repetitive behavior because it’s something people do repeatedly, not just the occasional nail-biting during an exam (compulsive skin and nail biting has another name—dermatophagia). Behavioral scientists have broken it down into two categories, automatic picking, which some may do even in their sleep without realizing it, and focused picking. It tends to begin around adolescence (sometimes as an urge to pick at acne), and the majority of those with dermatillomania are women, according to the APA—though women are more likely to seek treatment for it than men so it’s difficult to pinpoint that breakdown for certain.
The physical consequences of skin picking are scabbing and scarring, and there’s a risk of cellulitis (bacterial infection). Psychological consequences might be an immediate feeling of guilt from picking, shame and embarrassment from the scars, and anxiety about how to stop. People with dermatillomania report a lower quality of life and might experience social isolation.
When patients present with dermatillomania at their appointment with a primary care doctor or dermatologist, they’re likely referred to a therapist or mental health professional to help guide their treatment. Because it’s such a complex disorder, everyone facing dermatillomania will need a treatment plan that’s individually tailored to their experience. With time and help, it’s possible to manage dermatillomania behaviors and live years to decades without skin-picking.
Thanks to communities online, on Reddit and social media, skin-picking isn’t as unknown as it once was, but it’s still vastly under-studied. (Unlike so many other skin issues, there isn’t a medication or product directly marketed or made to treat dermatillomania, which maybe explains why there hasn’t been that many studies about it.) “You mean there’s a name for this?” commenters write, again and again, in message board threads about skin picking. And while there aren’t cut-and-dry easy answers about how to treat it, there are many paths people can take to find out how best to stop the urge to pick.
What Causes It?
There’s no direct cause of dermatillomania in the way that excess oil and bacteria cause acne. It’s a psychological condition that’s as complex as the human mind, and it’s slowly receiving more attention from the scientific community. A recent review of dermatillomania studies found that, broadly speaking, people who engage in skin-picking do it to cope with emotions, or for a feeling of escape.
Then there’s a laundry list of “mights,” possible triggers for dermatillomania that just haven’t been studied enough to show certainty. Genetics might come into play. A lack of serotonin, or other hormonal imbalances, might lead to compulsive behaviors. Some people might be picking as a way to cope with a traumatic event. It almost sounds too obvious to say, but it isn’t always easy to draw a direct line to explain why we do the things we do. This is why dermatologists direct patients with dermatillomania to mental health professionals, because the cause will differ from person to person.
What scientists do know about dermatillomania is that it’s often (but not always) present in people who are also experiencing major depression, anxiety, and/or obsessive-compulsive disorder (OCD), among others. It’s closely related to trichotillomania, which is when people compulsively pull out eyebrows and hair.
Skin picking might be a way for someone to cope with anxious thoughts, or skin picking might create anxiety about how they look, and how to stop. There isn’t a direct line of cause and effect with dermatillomania, which makes it harder to understand and treat.
How Can I Treat It?
A recent study in Comprehensive Psychiatry found that over 87% of people with dermatillomania have not been treated for it (and as we’ve seen in online comments from Reddit to YouTube to TikTok, many don’t even know that what they’re doing has a name and diagnosis). But that small percentage of people who had been treated for it found their treatment to be worthwhile. Hopefully, with more education and awareness, those who are experiencing skin-picking can seek treatment and find it.
Treating the immediate wound caused by skin-picking may require antibiotics, and in severe cases, surgery. It’s important to clean the open sore right away to avoid infection, and doctors suggest applying a hydrocolloid patch or bandaid (available at any pharmacy) to give the skin an environment to heal—and keep that area protected from future picking. A dermatologist can prescribe an ointment called triamcinolone acetonide to help treat scars caused by skin picking, and generally help guide a skin recovery plan that depends on the person’s scar severity.
Treating the underlying psychological causes of skin-picking is complex and will change from person to person. A psychiatrist might prescribe medication, such as antidepressants, which help create serotonin in the brain, hopefully restoring messaging from the brain to the body that helps resist the urge to pick (serotonin is a crucial hormone that helps us manage our moods).
Talk therapy is the most common treatment for dermatillomania. And those therapists commonly look to habit reversal training (HRT), which teaches people how to recognize their triggers and avoid them, as well as relaxation and coping techniques to reduce and redirect the urge to pick. What few studies there are on skin-picking have shown that HRT is an effective treatment for many. The TLC Foundation for Body-Focused Repetitive Behaviors keeps a database of medical providers who specialize in the field, among other resources.
But treating dermatillomania can be multi-faceted. Acne, atopic dermatitis (eczema), and keratosis pilaris (bumps on the skin) are triggers for some, who pick at the blemishes and bumps to make them go away; a dermatologist can help treat those specific skin issues to help reduce that potential trigger. A Refinery29 contributor wrote about how acrylic nails keep her from picking because they aren’t as sharp as real nails. Others may try hypnosis. For the UK artist Liz Atkin, creating art and charcoal drawings helped her manage her skin-picking, which she’s turned into an online movement and educational TEDTalk. Activist and current Miss America Emma Broyles has spoken about her dermatillomania and how she learned to avoid mirrors (her trigger was seeing pimples on her skin) and began journaling to deal with stress. There’s even a SkinPick app that helps people identify and reduce skin-picking symptoms.
That’s all to say: There’s not one formula for treating dermatillomania, it might just take some time to find the one that works for you.
What Prevents It?
Preventing and treating dermatillomania are one and the same. In order to stop picking the skin, you have to find a way to stop the urge to pick, which might require medication, behavioral therapy, or a coping mechanism like drawing. And in turn, those same treatments will help prevent picking the skin in the future.
For example, hormone inhibitors, like antidepressants and mood stabilizers, may help prevent dermatillomania by keeping the brain from creating the urge to pick. Habit reversal training, which helps people recognize the triggers and feelings that precede picking, can help prevent the action by teaching relaxing techniques (maybe a breathing exercise) to keep the urge from taking over.
It’s important to note that you can’t “cure” dermatillomania but you can find (many) ways to manage it. Finding the best treatment for the person experiencing it might be challenging and take time, but when they do, they might be able to live the rest of their life without picking again.
Citations
Excoriation (skin-picking) disorder: a systematic review of treatment options by Christine Lochner, Annerine Roos, and Dan J Stein.
What Is Skin Picking Disorder? by the International OCD Foundation.
Dermatillomania by Cleveland Clinic.
Dermatillomania by Psychology Today.
Re-imagining Compulsive Skin Picking: Art for Recovery, by Liz Atkin, TED Talk.
People With Dermatillomania Are Turning To TikTok To Spread Awareness by Nicole Fallert, Buzzfeed.
Fighting the Shame of Skin Picking by Lindsay Gellman, New York Times.
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