Experts give us the lowdown on skin-picking disorders & when we should seek advice
The success of Dr Pimple Popper (4.4m million Instagram followers and counting) has confirmed what we all secretly suspected –most people find squeezing spots and picking at ingrown hairs satisfying (though this in itself carries a risk of infection and scarring). But while we all occasionally pick our skin one way or another, sometimes skin picking behaviour can go beyond a simple pop and squeeze, and become a compulsion.
"Skin picking, also known as dermatillomania, excoriation disorder or skin picking disorder, is a body-focused, repetitive behaviour that occurs when a person cannot stop picking their skin," explains Dr Alia Ahmed, consultant dermatologist and psychologist.
Here, two leading skincare experts answer our questions on this little-understood condition.
What is a skin picking disorder?
"Compulsive skin picking involves compulsive picking at your skin, a scab, moles, freckles or spots to the point that it causes a fair amount of damage," explains Dr Adam Friedmann, consultant dermatologist at Stratum Clinics.
"Commonly affected areas are the face and arms, but almost any area of skin can be picked (eg, legs, intimate areas etc)," explains Dr Ahmed.
"Although skin picking for most is done using the hands/fingernails, people can use other instruments, for example, tweezers. The time spent engaging in skin picking can vary, sometimes it can last for hours."
And although skin tends to repair itself, there is "often a lot of scarring left behind following sessions or episodes of skin picking", says Dr Friedmann. "It is a recognised psychological phenomenon."
How many of us are affected by a skin picking disorder?
Affecting as many as one in 20 people, studies show that skin picking can be a symptom of other mental health conditions including depression and anxiety.
"Skin picking disorder tends to affect females more than males," says Dr Ahmed. "It is clinically classified under obsessive compulsive disorders (OCD) and related behaviours are nail biting, hair pulling and plucking."
"Other related conditions we are picking up in people that skin pick are attention deficit hyperactivity disorder (ADHD), as well as anxiety and depression."
Why does skin picking happen?
According to Dr Ahmed, there are several reasons why people become engaged in this repetitive and often damaging behaviour:
1. Underlying skin conditions: acne or eczema, among others, can promote picking in response to a lesion (eg, a spot or scab), or symptom (eg, an itch). Treatment of the underlying condition coupled with appropriate psychological interventions can lead to reduction or cessation of picking.
2. Emotional picking: people tend to pick their skin in response to psychological states, such as stress and anxiety, or anger. Recognising these triggers is important when trying to break the skin picking cycle.
3. Habitual picking: some people engage in skin picking out of habit. This occurs in a state of boredom, or when idle or feeling tired.
4. OCD: skin picking is related to other obsessive compulsive behaviours. If you have other associated behaviours, such as frequent handwashing, hair pulling or plucking, ritualistic behaviours or excessive tidying, skin picking can be a sign of further undiagnosed problems that could benefit from treatment.
What problems can skin picking cause?
"Our skin is already colonised with bacteria, so breaking the natural barrier through picking can allow surface or other harmful bacteria to enter," explains Dr Ahmed.
"This may cause inflammation, bleeding and/or pain. In extreme cases, infection can manifest as collections of pus, and cause other problems like fever, especially if bacteria enters the bloodstream."
Frequent picking and an ongoing reparative response by the skin to inflammation or infection can also result in pigmentary changes. "Skin in picked areas can become lighter or darker than your normal skin tone," says Dr Ahmed. "It can also result in scarring or physical disfigurement (eg, picking a hole in the skin to cause an ulcer)."
"Skin pickers can develop nail deformities as they typically use their fingernails to pick or cause repetitive damage to the cuticle by picking at it. These can manifest as horizontal ridges in the nails."
If you’re experiencing any of these symptoms, book an appointment with your GP who will be able to prescribe medication, if appropriate, as well as provide help and advice, and a referral if necessary.
Beyond the physical, skin picking can also cause emotional distress, as well as mood or anxiety problems. "People may be feeling embarrassed and socially isolate themselves as a consequence, or spend excessive time disguising it with clothes or make-up," says Dr Ahmed. "I usually discuss additional treatment, such as psychological interventions."
Dr Friedmann agrees, saying: "The main treatment will fall into the spectrum of cognitive behavioural therapy (CBT) to try and correct the psychological drivers causing the problem."
How to help stop skin picking
Recognising triggers is important when trying to break the skin picking cycle. "I suggest noting when or where you commonly pick," explains Dr Ahmed. "Keeping a daily journal, either as a notebook or on your phone, to jot down any thoughts/feelings/situations that promote picking can be very useful. Thoughts, feelings, or situations that promote picking can then be identified and dealt with."
"If a skin condition is predisposing you to pick, for example acne, seek appropriate medical treatment as a first option."
She adds: "Cover hands and fingers where possible, especially if these are what you use to pick, keep natural nails short if you use them to pick – false nails may be a deterrent as you are likely to want to avoid damaging them by picking and, if you use an instrument to pick, make this as inaccessible as possible."
"Keep your hands busy rather than picking, for example, squeezing a stress ball, clenching and unclenching hands, moisturising or massaging. This less harmful behaviour can over time replace skin picking and, if you get the urge to pick, moisturise your hands for a minute instead of picking, or clench your hands into fists for 15 seconds and then release."
Work up the time you resist the same way you’d strengthen a muscle. "Try to resist picking each time you feel the urge, start by resisting for one minute then slowly increase by a minute at a time," says Dr Ahmed.
Where to seek support for skin picking
You should see your GP if you can’t stop picking your skin, you’re causing serious damage to your skin by picking it, such as cuts that don’t heal within a few days, or it’s causing you emotional distress or affecting your day-to-day life.
"People with a skin picking disorder are often embarrassed or anxious about their actions and so do not tend to seek medical help", explains Dr Friedmann.
‘It is vital to seek help because, with appropriate psychological support, it is possible to overcome the condition, although it does take time.
Dr Ahmed also advises setting up a form of support group with someone you trust at work or at home. ‘Ask them to tell you if they see you picking, so you are made aware and more likely to stop,’ she says.
As Dr Friedmann mentioned previously, CBT can be also useful to break the skin picking cycle.
Visit your GP for advice and support, or, if you live in England, you can refer yourself directly to an NHS psychological therapies service (IAPT) without a referral from your GP.
Other sources of information available are stoppicking.com for an online programme designed to help people stop picking, Headspace for mindfulness and other relaxation techniques and The TLC Foundation for body-Focussed Repetitive Disorders.