I know that many of you may find it irresistible to pick and squeeze acne blemishes and scabs which pop up on your skin. However, there are individuals who take this compulsion to an extreme and create abrasions and divots in their skin even when there is no blemish in sight. These people suffer from a form of obsessive-compulsive disorder known as dermatillomania or skin picking disorder.

The characteristics which separate a dermatillomania sufferer from a relatively “normal” tendency to pick are:

• Repetitive picking at the skin
• Picking which is severe enough to cause tissue damage
• Social distress

People who suffer from skin picking disorder also commonly have depression and/or anxiety and low self-esteem. Common areas which sufferers tend to pick at are the face, scalp, cuticules, arms, forearms, back, hands and feet. Most of the time people will pick with their fingernails, but may also use their teeth, tweezers or scissors. This tendency may be triggered by boredom, stress, or anger, and is often such an absent-minded activity that people may not even be aware that they are picking. The picking behavior often provides relief from tension, but what frequently follows is guilt and feelings of shame. The most extreme cases are best treated with psychotherapy and medication, while milder cases can often be successfully treated with behavior modification.

I frequently see patients who have neurotic excoriations (areas of irritated, abraded skin) and areas of brown hyperpigmentation (from older spots which have been picked) which are dead giveaways to skin picking disorder. The typical patient I see is anxious and perceives any real or fabricated skin imperfection is distorted in significance. The sufferer may experience satisfaction after picking at the skin, but a vicious cycle sets in by which the open sores are constantly picked at, making them far worse and decreasing the likelihood that they will heal without some permanent scarring.

Here are a few suggestions for mild skin pickers to practice in order to break the cycle of picking.

1. Avoid spending excessive amounts of time looking in the mirror for areas to pick.
2. Remember that the zone of infection is an inverted triangle spanning across the eyes and down to the area below the mouth.
3. ANY area of the skin that is picked at can develop infection.
4. Keep fingernails short to make it more difficult to use your nails as a picking tool.
5. Avoid using tweezers to pick at skin.
6. When you get an acne blemish, DO NOT pick at it or attempt to extract it. Instead, apply ice to the blemish, use hydrocortisone cream, or apply old fashioned toothpaste (Crest original formula is perfect) to the blemish.
7. Remember that an acne blemish is far better than an abrasion, scab that doesn’t heal from constant picking, brown hyperpigmentation, or a permanent sunken scar.

I am saddened by the people who come in for cosmetic dermatology treatments who exhibit the signs of skin picking disorder. The most common patient is female, between late teens to early 40’s, and has a palpable anxious energy. Though I can always spot a patient with the disorder by the telltale excoriations, the patient’s embarrassment is heightened when the cover-up makeup comes off and I can see hyperpigmentation from areas that were picked at previously. I cannot tell you how many attractive women have come into my office who have essentially ruined their skin by picking at it. No blemish is worth picking at, especially when permanent scarring can result.