Skin picking disorder

Excoriation (or skin picking) disorder is an under-recognized condition added to the psychiatric diagnostic manual in its last revision. It involves repeated skin picking resulting in noticeable tissue damage.

Though it has been discussed in medical literature for more than a century, excessive skin picking was only recently added as a psychiatric condition.

Individuals with this urge to pick have likely attempted to reduce or stop picking more than once, and are distressed by the behaviour.

People with this condition often spend several hours every day picking at their skin. Situations that trigger picking are different for every person but can include stress, anxiety, boredom, fatigue or anger. Picking can also be triggered by the feel or look of the skin.

Often, the individual doesn’t notice picking at first, but becomes aware of it when the spot begins to bleed or when someone else notices the behaviour.

Although it can range in severity, the picking can cause social embarrassment and interruption to work and life obligations as well as tissue damage, scarring and sometimes serious infection.  They may not want to leave the house because of embarrassment about their appearance.

Skin picking disorder can begin at any time in life, but looks the same in all age groups and across cultures. It affects between 1.4 and 5.4 percent of people. It is typically a chronic, lifelong issue that may wax and wane in its severity, but generally changes little over time.

It is quite rare for individuals with skin picking issues to seek treatment. It is estimated that less than 20 percent of those with this condition seek help.

Until recently, there has been little research and no specific treatment for skin picking disorder. A few studies examining serotonin reuptake inhibitors had mixed results. 

A recent US study found positive results with the use of N-acetylcysteine. This is an amino acid that appears to restore extracellular glutamate concentration in the nucleus accumbens – glutamate dysfunction has been implicated in compulsive behaviours and improving this has been associated with improvement in reward-seeking behaviour.

This study found a significant improvement in symptoms for those treated with N-acetylcysteine. It’s a promising start  but as there have only been a few studies with this condition to date, much more research is still needed.

In the meantime, some improvement can also result through cognitive behaviour therapy used for other ‘bad habits’ or even more serious grooming disorders such as the hair pulling of trichotillomania.





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