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  5. Excoriation Or Skin Picking Disorder: Symptoms And Best Ways To Treat It

Do you often find yourself picking the scabs on your skin? Even worse, is it usually a challenge to stop till you see lesions, scarring or bleeding?

You may be suffering from a mental condition known as skin picking disorder or excoriation. The condition is linked to the more widely present Obsessive Compulsive Disorder (OCD).

There's no need to panic as it can be addressed and cured with the right medication. Let's discuss all the causes, signs and treatments for skin picking disorder in detail.

What Is Excoriation Or Skin Picking Disorder?

Skin picking disorder or excoriation or dermatillomania is the habitual picking of skin, scabs, minor bumps or irregularities on the face and body.

People with the disorder are mostly aware of the problem and yet, unable to resist the urge to pick at their skin. At other times, people end up picking at their skin casually while their mind is engaged in some other activity. Patients may spend several hours in a day picking their skin.

Excoriation disorder is classified as a body-focused repetitive behaviour that can cause skin scarring and disrupt your life for several years. Gaining more knowledge about the condition will help you identify the skin picking triggers and understand how to deal with it.

How Does Skin Picking Disorder Develop?

Skin picking disorder or excoriation usually develops in childhood or puberty, when kids are used to picking their scabs. In some children, it further scars the skin, which makes them continue their action, leading to an unpleasant cycle.

Others may have almost absent-mindedly turned to picking the skin around their nails, scarring their fingers and picking those extra layers of skin. They later developed a sense of gratification from the repeated action.

The disorder could also develop in adults. If left untreated, it could be a chronic condition that gives you grief for several years. (1)

Signs & Symptoms Of Excoriation

Due to lack of awareness about the condition, many who pick their skin may not be aware that they suffer from excoriation disorder. Here are the most common habits of people with this disorder:

  • You spend a lot of time in the day picking your skin. This could be when you’re bored, doing some other activity or when you’re feeling stressed.
  • You may spend your time picking the skin around your nails, back or even picking at any imperfections on your face.
  • People with skin picking disorder will pick and pull at their skin until they bleed.
  • Due to the embarrassment that some patients feel, they often try to hide their scars from others. Remember that it is a very common condition and can be reversed.

What Causes Skin Picking Disorder?

It’s not scientifically clear or proven as to what causes someone to develop excoriation. Some people describe feeling the urge to pick or pull at their skin using their fingers or a pair or tweezers from as early as their childhood.

It may have first started after picking at a scab, which most children do. But children and adults with skin picking disorder are not able to control this behaviour.

Some may turn to skin picking during times of stress. People describe that they inadvertently pick at the skin around their nails while they are having a stressful thought and the skin picking itself offers them a sense of gratification and distraction.

Some people have described feeling an itchy, tingling sensation in the skin that they usually pick, leading them to pick skin in that same area again. Skin picking disorder is more commonly diagnosed among women.

Treatments For Skin Picking Disorder

1. There is research that shows treatments for skin picking disorder include Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT).

2. The therapies usually involve identifying the triggering factors and shooting various methods to destress and divert your mind from picking. This can include anything from using a stress ball to solving a puzzle or covering the affected area to prevent picking.

3. According to the International OCD Foundation, medications such as selective serotonin reuptake inhibitors and certain anti-seizure drugs may also be helpful in treating skin picking disorder or excoriation. (2)

4. According to The Trichotillomania Learning Center for body-focussed repetitive behaviours, although many studies have proven that symptoms of skin picking disorder reduced among patients who were prescribed certain medications, the results are not conclusive. (3)

5. You can consider using a topical steroid or an antihistamine cream to reduce itching or a tingling sensation in the spots where you have picked the skin.

6. Studies suggest that glutamatergic agents and a glucose isomer Inositol can also help in reducing the symptoms of this disorder. (4)

7. However, it is important to first understand whether it is indeed excoriation disorder before turning to a treatment method. Skin picking can be a sign of some other disorders such as substance abuse disorder and certain developmental disorders. Consult your doctor for the right diagnosis.

Precautions: Dos & Don’ts

  • The first step in controlling excoriation disorder is to keep an eye out for the triggers.
  • Try and zero in on the times during which you notice yourself picking your skin - it could be during some mundane daily activity, while doing a stressful activity or even while watching TV.
  • One highly recommended method to prevent skin picking is stimulus control - making a hostile environment for skin picking. If you use your fingers to pick your skin, trim your nails so you don’t cause too much scarring. Consider wearing gloves to fight the urge to pick your skin.
  • Some experts even recommend clenching the fists for around one minute whenever you get the urge to pick your skin. Doing this multiple times may prevent the urge to pick your skin from making a comeback.
  • You can also try using fidget spinners and stress balls to keep your hands occupied and to prevent the urge to pick your skin.
  • Instead of hiding your condition from others, be open about it with people you trust. Ask them to help you by calling you out whenever they spot you picking your skin.

What Happens If You Pick Your Skin Too Much?

Apart from the obvious effects of picking your skin, the scarring, lesions and bleeding can even lead to infections, a lot of anxiety and clinical depression.

Being a chronic condition, skin picking can affect the quality of your life for a really long time, if left untreated. Skin picking disorder may cause anxiety and problems in your social life.

With this type of disorder, people tend to hide the condition and its symptoms from others, often through wearing full-sleeved clothes and by applying a bandage on the area around the nails where people are most prone to pick skin. You may feel a lot of anxiety, trying to hide your scars and wounds from others.

The best solution is to face it and try the right ways to cure the disorder. Get help from a professional psychologist or psychiatrist.

How To Heal Skin Picking Wounds?

You can consider using a serum or medicated ointments to prevent hyperpigmentation or discolouration in the areas where you pick your skin.

Adopt a daily skin care routine and acne treating medication if you are prone to picking at blackheads, zits and any imperfections on your face.

Try not to pick at scabs that are healing - this will only delay the healing process and could also leave the wound open and vulnerable to infections.

Do Skin Picking Scars Go Away

When you pick the skin around your nails, the skin will heal in a few days without leaving any permanent damage. If you have been repeatedly picking at one scab however, there are chances it could leave a permanent scarring.

When you pick a scab, it leaves the wound open, making it vulnerable to further infection. Picking at it also makes it harder for the wound to heal.

Make sure never to pick a wound or scab that has not healed yet.

Why Is Picking Scabs So Satisfying?

Some people who pick their skin describe getting a notable sense of satisfaction while picking their skin.

They may experience a tingling or itching sensation in the area where they usually pick their skin, which is described as the ‘urge’ to pick skin.

This is usually followed by a considerable amount of time spent picking skin and a feeling of gratification. Some people also describe feeling both gratification as well as distress over causing self-harm and not being able to control oneself, at the same time.

Wrapping Up

Do remember that excoriation disorder is one of the most common forms of body-focussed repetitive behaviours. There is hence no reason to feel alone and helpless about your condition.

There are ways to treat skin picking disorders- the most effective one being touted to be cognitive behavioural theory and acceptance and commitment therapy. There are also some simple tips and strategies you can follow to make it difficult for yourself to pick skin- this is called stimulus control.

Consult a dermatologist to properly diagnose the condition and then chalk out a proper treatment plan.

Begin By Knowing Your Skin