Others

Excoriation (Dermatillomania)

Skin-picking disorder is characterized by frequent picking of skin until it causes lesions and bleeding

Ritika Dhaliwal

Kunal is a 23-year-old model. He has been modelling for 4 years now. During one of his shoots, his make-up artist noticed that he had some lesions and scabs on his arms and chest that had to be concealed. His girlfriend, who lived with him, had also seen him picking his skin frequently while watching TV. She took him to a dermatologist when the condition became so severe that he wouldn’t stop until the skin broke out and began bleeding. The medication prescribed by the dermatologist helped heal the lesions, but didn't address the root cause. Soon, Kunal began picking at his skin again.

Kunal's dermatologist then referred him to a psychologist. After some some personality assessment tests, Kunal was found to have some obsessive compulsive traits and low impulse control. He was sent in for therapy and given some medication, which helped him stop picking at his skin and practice some impulse control.

Excoriation or dermatillomania is commonly known as skin-picking disorder. It is characterized by frequent picking at the skin until it causes lesions and bleeding. Most people pick at their skin occasionally, like picking on a scab or the skin around the nails. But those with this disorder do it much more frequently, and to the extent that it results in skin blemishes, tissue damage, and even scarring.

The skin-picking may be triggered due to different reasons; one of which could be that the person is attempting to change or remove a perceived physical imperfection. People with skin-picking disorder usually feel a general sense of unease or tension that abates once they pick their skin.

Dermatillomania or excoriation is generally known to begin in early adolescence, although it can begin at any age. It can become a chronic condition if left untreated. Approximately 1.4% of the population lives with dermatillomania in a way that it leads to noticeable damage or distress, and causes impairment in the individual’s daily functioning. Of the affected, 75% are women.

What are the signs of excoriation?

  • Skin lesions or scabs in the absence of any dermatological conditions
  • Lesions resulting from recurrent picking
  • Inability to stop the behaviour
  • Distress and impairment in daily functioning
     

What causes excoriation?

No known causes have been identified as yet. It has been found to be something that exists alongside other psychiatric conditions like anxiety and depression. It might also be the individual's way of coping with difficult, painful emotions.

Treatment of excoriation

Treatment of excoriation involves both medication and therapy.

Medication: Antidepressants work well to reduce obsessive thoughts and compulsive behaviour. For these reasons, antidepressants are often prescribed for persons with excoriation disorder.

Therapy: Cognitive Behaviour Therapy (CBT) has been beneficial in helping people with excoriation retain control over their thoughts and feelings. Being more aware of their own thoughts and feelings can help them bring about a change in their behaviour.

References

- Wilhelm, S., Keuthen, N. J., Deckersbach, T., Engelhard, I. M., Forker, A. E., Baer, L., ... & Jenike, M. A. (1999).

- Self-injurious skin picking: clinical characteristics and comorbidity. The Journal of clinical psychiatry, 60(7), 454-459.

White Swan Foundation
www.whiteswanfoundation.org