Written by Stephanie Sutton, M.D. –
Do you notice that you occasionally pick at your skin? You are not alone. A recent study found that 63% of randomly selected participants engaged in some form of skin picking. 5.4% reported significant skin picking. Some patients even meet a psychiatric diagnosis of skin-excoriation disorder when the picking leads to tissue damage, distress with their daily life, and repeated trials to stop or decrease the picking.
Imperfections in the skin are often a trigger for skin picking. Examples include acne, scars, bug bites, or abrasions. Anxiety, stress, and boredom can exacerbate skin picking. Picking at your skin can lead to redness, it can inhibit the area from healing, and it can even lead to wounds and scarring. The face is the most common area for picking and secondary locations include hands, fingers, arms, and legs. Many people pick at the skin around their fingernails.
Habit reversal training (HRT) is a type of behavioral therapy that can help you stop picking at your skin. The main aspects of HRT include self-monitoring, awareness training, competing response training, and stimulus control procedures.
Self-monitoring and awareness help you to realize when you are picking at your skin and what environments are a trigger. Many people do it out of habit or subconsciously without realizing what they are doing. Once you acknowledge that it is happening, you can challenge the urge to pick and find other things to do with your hands instead such as sitting on them, drawing, folding them in your lap, or evening gardening. Horticulture therapy (gardening) has interestingly been used to help people who have skin-excoriation disorder or trichotillomania (hair-pulling). Over time with intentional resistance to act on the urge of picking or pulling and utilizing a competing response, the habit goes away or is reversed. Hence the name – habit reversal training.
Source: Grant J, Chamberlain S. “Trichotillomania and Skin-Picking Disorder: An Update.” Focus Psychiatry Journal. 2021 Fall;19(4): 405-410.
Stephanie Sutton, MD, is a contributing author to the Sutton Dermatology Blog. Stephanie Sutton is a psychiatrist and she focuses on wellness.