I Deal with Skin Picking Disorder. Here Are Six Tips I Learned from a Psychiatrist and a Dermatologist

published May 17, 2022
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Tucked in bed in the glow of my nightlight, I began twisting and twirling my hair as I thought about my upcoming book report presentation, what I’d wear to school tomorrow, and who I’d invite to my bat mitzvah party in the fall. In the midst of fretting about the guest list, I paused, realizing my fingers were no longer casually twirling my hair but had at some point inevitably moved to a habitually dry spot on the back of my scalp, which now felt sticky and damp. My heart sank as I flattened my hair back down over the open wound, turned onto my stomach and slid my hands under my pillow, swearing to myself I’d never pick again.

Years later, I was standing in front of the bathroom sink in my usual position: so close to the mirror that my breath kept fogging up the glass. By eleventh grade, acne had appeared on my forehead, cheeks, and chin, and despite trying a number of creams and washes nothing seemed to help. So each morning I took matters into my own hands. In a trance-like state I scanned for bumps and clogged pores to squeeze and pick, feeling relief with each blemish I took on. When I saw nothing left to attend to, I stepped away from the mirror and noticed how much more red and splotchy my face had become. I had no idea how much time had passed while I’d picked, but when I looked at the digital clock next to me I realized I was now running late for school once again.

A decade later, I’m sitting on the couch with my boyfriend. We’re 40 minutes into the new reality competition show we’ve been binging and he’s turning up the volume as I’m mindlessly fidgeting in my lap with a squishy pile of pink goo. A few weeks ago I’d have been asking him to pass me a tissue by this point in the episode, and he’d frown at me as I’d wrap it around a finger, where blood would be pooling around the edge of my nail. But now I have my silly putty, which I rely on to keep my hands busy and away from my skin not only on the couch, but while at my desk, in the car, and on the phone.

In fact, I recently sat kneading the neon blob as I phoned Lisa Zakhary, a psychiatrist and medical director at Massachusetts General Hospital Center for OCD and Related Disorders, to learn more about skin picking disorder (also called excoriation disorder or dermatillomania). It’s something I’ve dealt with for most of my life, stopping occasionally for a few months at a time before eventually starting back up again.

As Zakhary explains it: “Skin picking disorder is characterized by repetitive picking of one’s skin, but it’s different from the typical skin picking we all do from time to time because it’s very hard to stop.” She also adds that “the picking causes some kind of major distress or impairment, and can result in skin damage.” It often starts in adolescence and can ebb and flow from there.

If that sounds like you too, Sara Phillips, a Massachusetts-based dermatologist, wants you to know you’re not alone: “Most of the time people don’t love to say they’ve been picking, but it’s not uncommon. And there is support and people who are willing to help,” she says. With that in mind, I asked Zakhary and Phillips to share some of their top tips for those suffering from skin picking disorder. Here’s what they had to say. 

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If you are picking, pay extra attention to hygiene.

There’s always a chance for infection when you touch an open wound on your skin, but you can minimize the likelihood through one simple move: Wash your hands before you pick. If you’re particularly worried about infection (like if you have a weakened immune system or medical condition such as diabetes), you could also use an antibacterial wash in the shower, Phillips says. But word to the wise: Those can sometimes dry out your skin, making discomfort or itching worse, she adds.

See a dermatologist.

While chronic skin picking is a mental illness, consulting a dermatologist can often help, especially if picking is being prompted by a skin condition like acne or eczema. “Many times if picking is triggered by a dermatologic condition, that picking can be significantly reduced just by treating the dermatologic condition,” Zakhary explains. Your dermatologist likely will recommend a solid, gentle skincare routine that’s hydrating and fragrance-free, Phillips says, and can prescribe topical ointments plus offer any in-office skin treatments that might be helpful. 

Understand your triggers.

There are so, so many different factors that can set off picking, from anxiety or depression, to dermatologic conditions like acne or ingrown hairs, to boredom or having idle hands. There also might be a particular room in your home where you tend to pick, for example in the bathroom with the door closed.

Knowing what your skin picking triggers are will help you (and your therapist, if you have one) better identify an appropriate treatment. “If picking is triggered by depression or anxiety, I’m really going to focus my treatment on optimizing treatment of depression and anxiety,” Zakhary explains. “If it’s triggered by a dermatologic condition such as acne I’m going to make sure I involve a dermatologist.”

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Seek out cognitive behavioral therapy.

Although only 20 percent of people dealing with skin picking disorder seek treatment, CBT, or cognitive behavioral therapy, is proven to help those with SPD. “CBT is a really effective therapy for many different mental health conditions, as it’s a very structured type of psychotherapy that tries to modify behaviors and produce healthier ones,” Zakhary says. 

The CBT approach for skin picking disorder is unique to the condition, however, and includes two types of therapy: stimulus control and habit reversal training. “Stimulus control is basically a strategy to make it harder to pick by modifying your environment,” Zakhary says. So you might wear gloves, keep your skin covered, or apply skincare masks or lotions that feel soothing to the skin. There are also hundreds of “sensory substitutes” that you can use to keep your hands occupied during times when you’re most likely to pick, like playing with silly putty or a stress ball, knitting, or painting your nails. You can find a larger list of items and activities to keep your hands occupied through the TLC Foundation for Body-Focused Repetitive Behaviors.

In the second form of treatment, habit reversal training, “Individuals are basically taught to engage in a harmless motor behavior that’s incompatible with skin picking, so clenching your fists, for example,” Zakhary says. You would clench your fists for a minute when the urge to pick arises, and if the urge remains you’d repeat it for another minute. “Over time if you keep doing this habit reversal training the urges will lessen,” Zakhary explains. 

It’s also worth noting that while there are no FDA-approved medications specifically for skin picking disorder, studies have also shown that medications like SSRIs and N-acetylcysteine, an over-the-counter antioxidant supplement, can be helpful additions to CBT.

Use “Band-Aids” as short-term solutions.

While confronting the mental and emotional aspects of your picking are the keys to truly conquering the disorder, there are some short-term aids you can incorporate to lessen the likelihood of picking. This can be helpful if you’re trying to quickly clear your skin for an upcoming social event, for instance. If your bathroom is a particular hotspot for your picking, you might choose to temporarily cover up the mirror or remove any magnifying mirrors in your home. Zakhary also suggests using Band-Aids (of the literal kind) to cover your lesions, or put them on the fingers you use to pick to prevent yourself from doing so. “I often recommend blister Band-Aids — they’re waterproof and will stay on for a couple of days,” Zakhary says.

Try not to be too hard on yourself.

You might feel ashamed after a picking stint or embarrassed about failures to stop, but know that is a completely normal part of dealing with the disorder. “This is a condition that is marked by an inability to stop,” Zakhary says. “The way of stopping is not to shame yourself, but to try and seek help.”

If you deal with skin picking disorder and are seeking support, you can search for a support group near you or consider organizing your own through the TLC Foundation for Body-Focused Repetitive Behaviors.