Excoriation: Symptoms and Management

Excoriation disorder may also be referred to as skin-picking disorder or dermatillomania, and is considered part of the Obsessive Compulsive (OCD) class of psychiatric disorders. It's characterized by repeated picking at one’s own skin or nails that unfortunately leads to swelling, bleeding and discomfort, in addition to negative emotions like guilt and shame and sadness. It's also considered a body-focused repetitive behavior (BFRB) that generally begins in one's youth and continues throughout their life unless treatment is sought out. The condition affects between 1.4 and 5.4% of American adults and is more common in women than men.

Individuals may pick at healthy skin, minor skin irregularities (e.g., pimples or calluses), open wounds, blisters, scabs, or other types of lesions. This disorder is usually chronic, with intermittent remission of no picking alternating with periods of greater symptom intensity. If untreated, skin-picking behaviors may come and go for weeks, months, or years at a time. It is common for individuals with this disorder to spend significant amounts of time, sometimes even several hours a day, on their picking behavior. People may use their fingers or other tools, such as tweezers or pins to assist their picking.

Causes:

Both genetics and environmental causes have been proposed. There seems to be a connection with stress and anxiety as triggers, but also those with a history of atopic dermatitis (eczema). From my experience with patients, other OCD presentations are common and most have a tendency toward perfectionism.

Symptoms:

Recurrent skin picking and the inability to stop is the hallmark of this condition. Again, it may be seen as part of the OCD or anxiety spectrum and other presentations of OCD may be found such as fear of germs, need for symmetry etc.

Management:

Both medication management and Cognitive behavioral therapy (CBT) are seen as foundational to treat this condition. Habit reversal therapy (HRT), a promising therapy and one I employ with patients whom have this condition works, too. HRT consists of awareness training and then a competing response. Meaning, those that have Excoriation will gain more awareness about their triggers and what causes them to initiate the picking. They identify warning signs, which may be a thought, sensation or image. The competing response is then undertaken and is the opposite behavior to the impulse or in this case, the picking.

Nutrients:

Certain nutrients that may help include NAC, Glycine, and other ones researched for OCD such as B vitamins, Milk Thistle, Valerian, Fish Oil, Vitamin D and Turmeric. Since, OCD tends to be a hyperdopaminergic state, anything to lower Dopamine such as serotonin based medications, or even 5-HTP, or tryptophan may help too.

Dr. Newman is passionate about mental health and having patients reach their potential in health and wellness. He's the CEO and main provider for Trivita Health Center, an innovative telepsychiatry practice that blends medication management, psychotherapy and the principles of integrative & functional medicine for extraordinary patient care.