What Is Dermatillomania?

A mental health professional can diagnose dermatillomania. Dermatologists can also diagnose it if they see signs, and then they will typically recommend mental health support, says Saami Khalifian, MD, a double board-certified dermatologist and skin cancer surgeon and the founder of the private cosmetic skin-care practice SOM Aesthetics based in Encinitas, California. “[A dermatologist’s] role is to manage the skin and guide recovery, while also connecting patients with psychologists or psychiatrists who can support the behavioral aspect,” he says.

• Ongoing skin picking
• Attempts to stop skin picking
• Disruption to everyday life, such as if you feel embarrassment or shame
• Itching that isn’t caused by other medical conditions or drugs
• Behaviors that aren’t caused by other mental health conditions, such as body dysmorphic disorder

Treatment for dermatillomania includes medical and therapeutic options.

CBT and Other Therapy

Acceptance and commitment therapy, which supports people in managing emotional triggers and increasing psychological flexibility, can also be effective, Wenzler says.

“These therapies help build awareness of picking behaviors, develop healthier alternatives, and address emotional regulation,” she says. They’re most effective when delivered by clinicians specifically trained in treating body-focused repetitive behaviors, she adds.

Medication Options

• Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs)
• Anticonvulsants, such as a medication called lamotrigine, which alleviates uncontrollable muscle movements
• Antipsychotics, which can alter the brain chemistry to address the issue
• Nutraceuticals, which are nutrition-related products that can alter mental health conditions. The amino acid supplement N-acetylcysteine in particular may be helpful.

Medication tends to be most helpful when you also have anxiety or depression, Wenzler says. Otherwise, she says therapy is generally more effective.

“If the skin shows signs of infection, I may prescribe topical or oral antibiotics to support healing,” Dr. Khalifian says. “Occlusive dressings and barrier creams are also helpful in protecting the skin and calming inflammation.”

Surgery

Alternatively, Khalifian says he may recommend regenerative laser treatments to rebuild the skin gradually. “For patients prone to picking, we take extra steps during recovery, like using transparent or silicone-based dressings to protect healing skin and reduce itchiness that might trigger the urge to pick,” he says.

That said, it is possible to reduce the severity of the disorder with early awareness and support, Wenzler says. “While no single method can guarantee prevention, being proactive — especially during adolescence when the condition often begins — can help minimize the likelihood of the behavior becoming ingrained,” she says.

Because one’s environment has so much to do with dermatillomania, altering that setting or engaging in other activities can dramatically reduce the urge to pick.

Avoid Triggers

Develop Effective Coping Skills

Since skin picking can be an emotional response, finding alternative, healthier ways to deal with those feelings (primarily with the help of a therapist) can help avoid skin picking altogether. Developing healthy coping strategies for managing stress and intense emotions and developing emotional regulation skills can make a meaningful difference, Wenzler says. Finding ways to calm down and de-stress can also help, such as going for a walk outside, playing with a pet, or doing something creative, she suggests.

Occupy Your Hands

Trim Your Nails

Seek Appropriate Medical Help

The type of medical care you need depends on what’s causing you to pick. If you tend to pick at acne lesions, for instance, proactively visit a dermatologist to treat the acne and reduce the desire to pick. “A simplified, barrier-supportive skin-care routine can also reduce the need to ‘fix’ the skin manually,” Khalifian says.

Dermatillomania:

• Typically begins around the time of puberty, about age 13 to 15.

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  “It often coincides with the stage when people start taking responsibility for their own grooming,” Wenzler says, adding that it can also begin earlier in childhood or later in adulthood.
• Affects between 1.4 and 5.4 percent of Americans

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• Is more common in women (making up about 55 percent of cases)

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• Has a remission rate of about 13 percent

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• Obsessive-Compulsive Disorder (OCD) As an impulse control disorder, dermatillomania falls under the category of OCD because it also includes recurrent thoughts, images, or impulses. Those struggling with dermatillomania may have other compulsions or obsessions as well.

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• Trichotillomania Another disorder on the OCD spectrum, this is an obsessive urge to pull one’s hair.

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  It’s also a body-focused repetitive behavior that shares characteristics and biochemical changes with skin picking.

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• Post-Traumatic Stress Disorder People with dermatillomania are more likely to suffer from post-traumatic stress disorder or childhood trauma, compared with others without those conditions.

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• Depression As many as half of those with skin picking also have depression, which is associated with a depressed mood, altered sleep and appetite, and impaired cognitive function.

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• Anxiety There’s a lot of overlap with anxiety, with anywhere from 21 to 63 percent of those with skin picking disorder also having generalized anxiety disorder. This is why SSRIs (a common anxiety treatment) are a treatment option for dermatillomania.

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• Attention-Deficit Hyperactivity Disorder (ADHD) According to one review, ADHD was the fourth most common comorbidity, affecting about 8 percent of the study participants.

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  This may be because ADHD increases the tendency to act on skin picking behaviors.
• Prader-Willi Syndrome A rare genetic disorder, Prader-Willi syndrome comes with a sense of being hungry all the time and may also include behavioral problems like skin picking.

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Pick, Pull, Bite: Finding the Light

This support group for body-focused repetitive behaviors meets monthly over Zoom. Those struggling with skin picking, nail biting, hairpulling, and other body-focused repetitive behaviors are invited to connect and share stories, support one another, discuss strategies, and practice acceptance.

Online Skin Picking Support Group

This group is led by the nonprofit Picking Me Foundation’s CEO, who has personally struggled with dermatillomania. It meets twice a month and brings together roughly 40 people each session. It serves as a safe space for people to share their struggles and strategies that have helped them avoid triggers and cut down on picking.

• Dermatillomania is a mental health condition on the OCD spectrum that involves obsessively picking at the skin so much that it disrupts one’s daily life.
• Dermatillomania is a lifelong condition that can be effectively treated with various medications and therapy options, though relapses can happen.
• The exact causes of dermatillomania haven’t been identified, but factors that may play a role include genetics, brain structure differences among those with the condition, and conditions such as stress, anxiety, or boredom.