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Excoriation (Skin-Picking) Disorder

A body-focused repetitive behavior involving recurrent picking of skin causing tissue damage and distress.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Psikiyatri department. Book Appointment →

What is Excoriation (Skin-Picking) Disorder?

Excoriation (skin-picking) disorder is classified in DSM-5 under obsessive-compulsive and related disorders. It is characterized by recurrent picking of one's own skin resulting in skin lesions, repeated attempts to decrease or stop skin picking, and clinically significant distress or impairment. The disorder is considered a body-focused repetitive behavior (BFRB), along with trichotillomania (hair pulling).

Skin picking can occur during focused episodes (where the person is fully aware) or in an automatic, dissociative manner (during sedentary activities like watching TV). Common targets include the face, arms, hands, and any perceived skin imperfection (acne, scabs, ingrown hairs). Patients use fingers, fingernails, tweezers, pins, or other instruments. The behavior may be preceded by tension or itching and followed by pleasure, gratification, or relief.

Excoriation disorder typically begins in adolescence, often around the time of acne onset, but can begin at any age. It is more common in females. The disorder is frequently associated with shame, embarrassment, and social avoidance due to visible skin damage. Comorbidities include anxiety disorders (especially OCD and trichotillomania), depression, and personality disorders. Skin damage can lead to scarring, infections, and rarely serious medical complications.

Symptoms

Recurrent skin picking resulting in skin lesions
Repeated unsuccessful attempts to stop or decrease the behavior
Significant distress, shame, or impairment
Targets typically face, arms, hands, scalp
Picking acne, scabs, perceived blemishes, healthy skin
Use of fingers, nails, tweezers, pins, or other tools
Time spent picking (often hours per day)
Skin damage: open sores, scarring, infections
Picking during focused or automatic states
Tension before picking, relief during/after
Avoiding social situations due to skin appearance
Excessive use of cosmetics, long sleeves to hide damage
Bleeding, scabbing, scarring, hyperpigmentation

Risk Factors

Female sex (75% of cases)
Adolescent onset (often coinciding with acne)
Family history of BFRBs or OCD
Comorbid OCD or anxiety disorders
Trichotillomania (hair pulling)
Depression
Body dysmorphic disorder
Stress or life transitions
Acne or other skin conditions (provides target)
ADHD (impulse control issues)
History of trauma or anxiety in childhood
Personality disorders
Sleep deprivation or boredom (triggers automatic picking)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Significant time spent picking interfering with life
  • Skin lesions, scarring, or infections from picking
  • Inability to stop despite multiple attempts
  • Shame or social avoidance due to skin appearance
  • Co-occurring depression, anxiety, or OCD
  • Picking with tools causing serious tissue damage
  • Children or adolescents with significant picking
  • Impact on work, school, or relationships
  • Suicidal thoughts related to appearance or behavior
  • Self-harm escalation

Treatment Methods

01
Comprehensive evaluation: psychiatric, dermatologic, medical
02
Cognitive behavioral therapy (CBT): primary evidence-based treatment
03
Habit reversal training (HRT): foundation of CBT for BFRBs
04
Specific HRT components: awareness training, competing response training, social support
05
Stimulus control: identifying and modifying triggers and high-risk situations
06
Comprehensive Behavioral (ComB) treatment: addresses sensory, cognitive, affective, motor, place factors
07
Acceptance and commitment therapy (ACT)
08
Dialectical behavior therapy (DBT) skills: mindfulness, distress tolerance
09
Pharmacotherapy: SSRIs (fluoxetine, sertraline) — modest evidence
10
N-acetylcysteine (NAC): glutamatergic, evidence in some studies
11
Naltrexone: case reports and small studies
12
Memantine: emerging evidence
13
Topical treatments: silicone gels, occlusive bandages to prevent access
14
Dermatologic care: acne treatment, wound care, scar management
15
Treatment of comorbid conditions: depression, anxiety, OCD
16
Support groups: TLC Foundation, online BFRB communities
17
Family education and involvement
18
Long-term maintenance and relapse prevention
19
Stress management and self-care strategies
20
Realistic expectations: chronic condition with periods of improvement

Which Department to Visit?

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.