Skin picking disorders

Abstract

Skin picking is characterised by compulsive picking of the skin by the patient resulting in skin damage. The picking may begin from an inflammatory dermatosis such as eczema or any pruritic condition and become more ritualistic. Or it may manifest itself de novo by repeated rubbing, picking or tearing at the skin which then leads to the development of skin damage. Patients feel the urge to pick at their skin and find relief in the activity. Any attempts to suppress the urge may cause an increase in psychological tension. Some patients may, however, engage in more automatic picking without full awareness of the behaviour and without any preceding tension. Where there is this lack of awareness, it may either be because the picking is habitual and automatic, or it can occur without full awareness in a dissociated state. There are several hypotheses about the underlying mechanisms behind skin picking, but the patho-aetiology is not fully understood. Patients do own that they have the habit of skin picking and this may help to distinguish skin picking from dermatitis artefacta spectrum disease. Skin picking is associated with other obsessive-compulsive cutaneous diseases such as trichotillomania and body dysmorphic disease. But some patients with skin picking may overlap with nodular prurigo, dysaesthetic disorders and substance misuse. Treatments include treatment of the skin together with the treatment of the psychopathology. The treatment of the psychological/psychiatric disease can be with talking therapies and/or psychopharmacology.