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Excoriation (Skin Picking) Disorder: What Is It?

What is excoriation?

Picking at scabs or bumps from time to time isn’t uncommon. But for some people, picking can become chronic. Frequent picking can irritate existing sores and even cause new ones to form. This can cause additional scabbing and lead to scarring.

This continued picking can develop into a condition called skin-picking disorder, or excoriation. People with this disorder pick at their skin out of habit or impulse. They often describe this impulse to pick as something they struggle to control.

Some people may spend a few minutes several times a day picking. Others may pick continuously for several hours each day.

Skin-picking disorder isn’t common, but it’s well documented. It’s considered a mental health condition related to obsessive compulsive disorder (OCD). Not everyone with OCD will develop skin-picking disorder, but many people who have this disorder often experience OCD, too.

Keep reading to learn more about excoriation, including why it may develop and how it can be managed.

Understanding the signs and symptoms of skin-picking disorder can help you recognize whether certain behaviors are the result of “normal” picking, or if they may signify something more serious.

For example, occasional picking is rarely problematic. Scabs often itch while the skin heals, leading many people to scratch at their skin. And despite advice to the contrary, many people pick at pimples and blackheads, too.

People with skin-picking disorder, however, may pick at scabs, bumps, pimples, or other skin lesions until they bleed again or become inflamed. They may also pick at the skin around their fingernails and toenails.

Sometimes, people with the disorder let the picked areas heal only to pick them again. It’s a cycle of habit and impulse that can be challenging to overcome.

Other signs and symptoms of skin-picking disorder include:

  • Trying to remove “imperfections”: Some people repeatedly scratch skin or try to rub out “imperfections” they think they see in their skin. This, too, can cause additional lesions, cuts, and sores.
  • Spending large amounts of time picking: Some people with this condition will pick at their skin several times a day. Others may pick for several hours at a time. Either way, the behavior can be a significant disruption to their social and professional lives.
  • Developing scars and infections from frequent picking: The disorder can lead to infections, lesions, and scars that last for long periods of time. Infections may require treatment with antibiotics.
  • Avoiding public events because of their skin: Frequent picking can leave skin covered in lesions and scars. Some people with this condition may avoid the beach, gym, or venues that require less clothing because of their skin’s appearance.
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Skin-picking disorder is a repetitive “self-grooming” behavior. It’s also called a body-focused repetitive behavior (BFRB). Other BFRBs include pulling hair or picking nails.

Skin-picking disorder is classified as a type of OCD. The compulsive urge to pick is often too powerful for many people to stop on their own. The more a person picks at their skin, the less control they have over the behavior.

It’s unclear what causes a person to develop this disorder.

The disorder often begins after one of two events or stimuli:

  • An infection, injury, or wound starts healing and creates a scab. The itching causes the person to scratch and pick. The new wound or lesion starts to heal and creates another scab. That begins the cycle of picking.
  • The behavior is a stress relief habit during a time of stress. The repetitive action and control that skin picking gives may provide relief from other events that can’t be controlled.

Skin-picking disorder occurs in both children and adults. It can begin at almost any age, but it typically appears first in adolescence or at the onset of puberty. Women are more likely to develop it than men.

Several conditions commonly occur alongside skin-picking disorder. These illnesses or disorders may be symptoms of a condition, or they may share many common underlying risk factors.

These co-occurring illnesses include:

  • Obsessive-compulsive disorder (OCD): This mental health disorder often causes repetitive behaviors that greatly interfere with a person’s quality of life.
  • Body dysmorphic disorder: People with this body-image disorder experience obsessive negative thoughts about how their body looks. This can lead to skin picking to remove “imperfections.”
  • Major depressive disorder: Depression can lead to a host of behaviors, including skin picking.
  • Trichotillomania (hair-pulling): Approximately 38 percent of people with skin-picking disorder also experience this condition.
  • Other BFRBs: Although hair-pulling is the most common co-occurring BFRB, others are possible. This includes nail biting, biting the lips until they bleed, and chewing on the inside of your cheeks.
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Skin-picking disorder can’t be self-diagnosed. Although you may suspect your symptoms are caused by skin-picking disorder, your doctor will want to rule out any other underlying conditions before making a diagnosis.

After performing a physical exam, your doctor will ask you about your behaviors and the feelings you have while performing the habit. They’ll also determine whether the lesions or scabs you’re picking are the result of a skin disorder or condition like eczema or psoriasis.

If your doctor suspects skin-picking disorder, they may refer you to a mental health professional. Family medicine…

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