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Do You Often Pick The Skin Around Nails? You May Have Excoriation Or Skin Picking Disorder?

Picking the skin, be it an area around the nails or freckles or moles or scars, is a common thing that people do occasionally. However, when this habit develops into a chronic behaviour, it could be a sign of the development of mental health disorder which may impact a person's overall health and quality of life.

Excoriation disorder is known by many names such as skin picking disorder, neurotic excoriation, dermatillomania or psychogenic excoriation. According to a study, excoriation disorder is a type of obsessive-compulsive and related disorder characterised as recurrent picking of skin, which may lead to skin lesions, scarring of the skin or other functional impairment. [1]

The prevalence of the disorder is 1.4 to 5.4 per cent and it may occur at any age, but is generally triggered in adolescence or with the onset of puberty.

In this article, we will discuss details on excoriation disorder. Take a look.

Causes Of Excoriation Disorder

The skin-picking disorder is considered similar to other obsessive-compulsive disorders like trichotillomania or hair-pulling disorder.

Other psychiatric disorders that may trigger the condition is Tourette's Disorder, obsessive-compulsive spectrum disorders, eating disorders, anxiety disorders and depressive disorders. [2]

Experts say that some skin conditions like eczema, scabs or acne can trigger a skin-picking disorder. Other triggers for excoriation disorder can be emotional like anger, stress, boredom and anxiety or sedentary lifestyle like lack of physical activities or watching television.

Excoriation disorder is often diagnosed in individuals with a history of the same or other obsessive-compulsive disorder. For example, if either of the parents has the disorder, the chances of passing it on to children are likely to be more when compared to the general population. This suggests the genetic predisposition of the condition. [3]

Note: Excoriation disorder has no specific cause and could be triggered due to various factors and may vary across individuals.

Symptoms Of Excoriation Disorder

  • Uncontrollable urge of skin picking, especially in the face, fingers, hands, arms and legs.
  • Inability to stop picking despite repetitive efforts. [4]
  • Spending several hours a day picking the skin, causing them to miss out on essential tasks.
  • Avoiding activities or situations where their skin lesions due to skin picking can be seen or detected.
  • Picking the pimples, bumps or scabs until they get inflamed or bleed again.
  • Sometimes, picking the healthy skin.
  • Picking the skin areas around toenails or fingernails is more common.
  • In rare cases, allowing the pick areas to heal so that they can again pick them again.
  • Repeatedly scratching the skin as they think they are removing the 'imperfections' from the skin.
  • Picking the skin out of depressive symptoms or stress or boredom.
  • Picking of the skin even with pins, tweezers or other tools.
  • A sense of relief after picking the skin or enjoyment while skin picking.
  • Not picking the skin in front of others, except for family members in some cases.

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Risk Factors Of Excoriation Disorder

Some of the risk factors for excoriation disorder are:

  • Gender
  • Being an adolescent.
  • Having some preexisting obsessive-compulsive disorders like ADHD.

Complications Of Excoriation Disorder

Continuous picking of the skin can lead to complications like:

  • Skin lesions that may require surgical procedures.
  • Poor quality of life.
  • Skin infections
  • Scarring of the skin
  • Serious physical disfigurement.
  • Onset of mood or anxiety disorders.
  • Feeling of embarrassment or shame while meeting with people.

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Diagnosis Of Excoriation Disorder

The severity of the skin-picking disorder is categorised from mild to severe. Only when the symptoms meet the diagnostic criteria, treatment is suggested. The main problem related to diagnosing the disorder is that only less than a fifth of patients seek treatment while most of the individuals do not even consider it a health problem.

Also, many people do not report the condition to a medical expert due to social embarrassment, thinking that a medical practitioner will not understand their situation or due to the belief that it is just a 'bad habit' that cannot be treated.

Skin-picking disorder is considered to be an obsessive-compulsive or related disorder and can be diagnosed based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). [5]

Treatments Of Excoriation Disorder

Some of the treatment methods for excoriation disorder may include: [6]

  • Cognitive-behavioural therapy: It includes habit-reversal therapy and acceptance and commitment therapy.
  • Medications: It includes promising medications like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors.

Mental Health Helpline Numbers

1. COOJ Mental Health Foundation (COOJ)- Helpline: 0832-2252525 | 01:00 PM - 07:00 PM ( Monday to Friday)

2. Parivarthan- Helpline: +91 7676 602 602 | 10:00 AM to 10:00 PM (Monday to Friday)

3. Connecting Trust- Helpline: +91 992 200 1122 | +91-992 200 4305 | 12:00 PM to 08:00 PM (All days of the week)

4. Roshni Trust- Helpline: 040-66202000, 040-66202001 | 11:00 AM - 09:00 PM (Monday to Sunday)

5. Sahai Helpline: 080-25497777 / Email at - SAHAIHELPLINE@GMAIL.COM | 10 AM- 8 PM (Monday to Saturday)

6. Sumaitri: 011-23389090 / FEELINGSUICIDAL@SUMAITRI.NET |2 PM- 10 PM (Monday To Friday); 10 AM - 10 PM (Saturday and Sunday)

7. Sneha: 044-24640050 (24 HOURS) / 044-24640060 | Email at- HELP@SNEHAINDIA.ORG |8 AM - 10 PM

8. Lifeline: 033-24637401 / 033-24637432 | Email at LIFELINEKOLKATA@GMAIL.COM | 10 AM - 6 PM

To Conclude

Excoriation disorder is a relatively common condition among the general population. Though the condition is discussed for over a century, it is still not considered a mental health disorder in many studies, leading to its lack of adequate diagnosis and treatment.

Consult a medical expert if you have a skin-picking disorder or know someone with this condition for early treatment.

Image Sources:, Freepik, Pexels

What causes excoriation disorder?

Excoriation disorder can be triggered due to various factors such as skin conditions like eczema, emotions like excessive stress, psychiatric disorders such as ADHD, or a history of obsessive compulsive disorder in the family.

Can excoriation disorder be cured?

With medications like selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapies, the excoriation or skin-picking disorder can be effectively managed.

Is excoriation related to anxiety?

No, excoriation is related to obsessive-compulsive disorder in which a person has obsession or irresistible thoughts to perform certain behaviours in a repetitive way which may affect their quality of life.

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