Skin Picking Disorder

Skin picking consumes hours a day for some individuals, causing disfigurement and interfering with social or work life. Skin picking disorder has a prevalence of 1%–5% and can arise at any age, often after the onset of a dermatological condition. Although it has similarities to obsessive-compulsive disorder and body dysmorphic disorder, it is distinguished by a personal or family history of grooming disorders and a lack of preoccupation with appearance. A dermatologist should determine whether the patient has an underlying skin condition and whether medical treatment is needed.

Although skin picking has been documented in the medical literature since the 19th century, only now is it receiving serious consideration as a DSM psychiatric disorder in discussions for DSM-5. Recent community prevalence studies suggest that skin picking disorder appears to be as common as many other psychiatric disorders, with reported prevalences ranging from 1.4% to 5.4%. Clinical evaluation of patients with skin picking disorder entails a broad physical and psychiatric examination, encouraging an interdisciplinary approach to evaluation and treatment. Approaches to treatment should include cognitive-behavioral therapy (including habit reversal or acceptance-enhanced behavior therapy) and medication (serotonin reuptake inhibitors, N-acetylcysteine, or naltrexone). Based on clinical experience and research findings, the authors recommend several management approaches to skin picking disorder.