Clinical Pearls for Excoriation (Skin Picking) Disorder

  • • Habit reversal therapy is the psychotherapy of choice.
  • • Medication options are unclear at this time although many people benefit from pharmacotherapy.
  • • Excoriation Disorder is often co-morbid with Trichotillomania, Body Dysmorphic Disorder, OCD, and major depression.
  • • Skin picking may have origins in other psychiatric conditions, including illicit substance use (methamphetamine), Body Dysmorphic Disorder, delusions of parasitosis, all of which must be ruled out.
  • • Infections resulting from skin picking are common and patients may require antibiotic or, in severe cases, surgical intervention.

Key References

  • • Odlaug BL, Grant JE. Pathologic skin picking. Am J Drug Alcohol Abuse. 2010 Sep;36(5):296-303.
  • • Tucker BT, Woods DW, Flessner CA, Franklin SA, Franklin ME. The Skin Picking Impact Project: phenomenology, interference, and treatment utilization of pathological skin picking in a population-based sample. J Anxiety Disord. 2011 Jan;25(1):88-95.
  • • Grant JE, Odlaug BL, Chamberlain SR, Keuthen NJ, Lochner C, Stein J. Skin picking disorder. Am J Psychiatry. 2012 Nov 1;169(11):1143-9.
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