What Is Excoriation (Dermatillomania)?
Medically reviewed by Kathleen Daly, MD
Excoriation, also known as skin-picking disorder or dermatillomania, is a mental health condition in which you repeatedly pick your skin and have trouble stopping. People with excoriation may pick the same spots on their skin continuously, which can lead to bleeding and swollen skin in different areas of the body. It’s related to obsessive compulsive disorder (OCD) and is primarily treated as a mental health condition despite its physical manifestation.
Around 1-5% of people in the United States experience excoriation. It’s more common among women than men. It generally begins around the same time as puberty, but it can occur earlier or later in life as well.
Excoriation Symptoms
The defining symptom of excoriation is repeated skin-picking behavior using your fingers, fingernails, teeth, or a tool such as tweezers. You may pick your skin without realizing it, or it may be a conscious behavior to reduce stress and anxiety or a physical itching feeling. Some people pick to extract objects that they believe are embedded under their skin, or they may pick at moles, freckles, and other skin “imperfections” to smooth them. You may not feel that you are able to stop yourself from picking.
You may notice that you spend weeks picking at the same spots, and then spend a few weeks not picking at all. Generally, excoriation is a chronic condition, meaning it can last for months or years. You may have cuts, bruises, or bleeding from your picking, often grouped in parts of the body that are easy to reach, such as your arms, legs, face, or upper back. These spots may take a significant time to heal, particularly if you continue to pick the same spots.
What Causes Excoriation?
Excoriation is within the family of obsessive-compulsive disorders, which are a number of mental health conditions in which repeated thoughts and actions can affect your daily life. It’s similar to trichotillomania, or hair-pulling disorder, as well as body dysmorphic disorder.
A combination of factors may cause you to pick your skin. You may find that you pick your skin more in response to:
Boredom
Distress caused by other mental health conditions
Guilt or shame
Experts aren’t sure exactly what causes excoriation. Research suggests that a few factors may play a role, including genetics or the structure of your brain, particularly in areas that control how you develop habits.
Diagnosis
If you feel unable to stop picking your skin, or your picking is causing you physical or emotional harm, it’s important to seek care from your healthcare provider. You can reach out to your primary care provider or speak with a mental health provider if you have one. They will begin by asking you about your behavior and may perform a physical exam on your skin. If they think you may have excoriation, they may recommend that you see a mental health provider, such as a psychiatrist, for diagnosis and treatment.
This mental health provider will likely use a series of psychological tests and ask about your history to make a diagnosis. They may ask for more information about your skin picking, if you’ve tried to stop, and how it’s impacting you. If necessary, they may refer you to a medical provider who can perform tests to rule out anything physical that could cause your symptoms, such as food allergies or atopic or contact dermatitis.
Treatments for Excoriation
As is the case with many mental health conditions, both psychotherapy and medication can be used to treat excoriation. Research is currently limited on the combination of talk therapy and medication, with most studies focusing entirely on one or the other.
Psychotherapy
Psychotherapy, or talk therapy, is an important treatment method for excoriation. Cognitive behavioral therapy (CBT) is the most researched form of talk therapy for treating this condition.
Specific types of CBT, including habit reversal therapy (HRT) and acceptance and commitment therapy (ACT), have been shown in research to be particularly helpful for people with excoriation. HRT helps you recognize your habit and replace it with a harmless one, while ACT focuses on acceptance and mindfulness strategies. In addition, new research shows that computer-based self-help interventions focusing on these principles may be useful.
Related: This Simple Trick Can Help You Stop Biting Your Nails or Picking at Your Skin
Medication
Your provider may prescribe you a medication to treat your excoriation symptoms, in place of or in addition to therapy. Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant often prescribed for depression and anxiety, are the most common medications prescribed for excoriation.
Some of the medications used to treat excoriation include:
Prozac (fluoxetine)
Celexa (citalopram)
Lexapro (escitalopram)
Luvox (fluvoxamine)
Zoloft (sertraline)
Prevention
In addition to a full treatment plan, you can consider everyday changes to help yourself reduce your skin picking.
Specifically, you can try:
Picking up a new hobby that keeps your hands busy, such as knitting
Putting on gloves or squeezing a stress ball
Spending time doing self-care for your skin, such as applying lotion
Asking loved ones to point out to you when you’re picking
Cleaning your skin regularly to reduce your chance of infection
Cutting your fingernails shorter
Storing tweezers and pins in harder-to-reach places in your home
In addition, you may find that self-care and stress management techniques, such as yoga and aerobic exercises, help reduce your symptoms. Holistic treatments such as acupuncture and hypnosis may also help, although more research is needed.
Related Conditions
People with excoriation may be at higher risk of other physical and mental health conditions. Some of the conditions that are related to excoriation include:
Obsessive-compulsive disorder (OCD)
Body dysmorphic disorder (BDD)
Trichotillomania, a condition in which you pull your hair out
Onychophagia, a condition in which you compulsively bite your nails
Depression, bipolar disorder, and other mood disorders
Prader-Willi syndrome, a chromosomal genetic disorder that can cause delayed development and intellectual disability
If you experience one of these conditions in addition to excoriation, it’s important to treat both. Often, the treatment for related conditions overlaps significantly, such as the use of SSRIs and talk therapy for both depression and excoriation.
Living With Excoriation
It’s important to seek care for yourself (or a loved one) if you think your skin picking may be excoriation. Only about one in five people with excoriation seek treatment because many people think it’s not a treatable medical condition, or they are embarrassed to admit they have been picking their skin. Treatment can be effective at reducing symptoms and may make a large difference in your quality of life, mental well-being, and ability to actively participate in school, work, and your social life.
Frequently Asked Questions
What is the difference between excoriation and abrasion?
Abrasions are any type of superficial injury, such as a cut or scrape, that breaks the skin. Excoriation is a type of abrasion of the skin caused by repetitive picking.
Is excoriation an infection?
No, excoriation is not an infection. However, it is important to keep your skin clean to avoid any wounded areas caused by excoriation from getting infected.
Is skin picking related to anxiety?
Yes, excoriation, or skin picking, commonly co-occurs with anxiety disorders.
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