Excoriation Disorder

This article provides an overview of excoriation disorder, including the main symptoms, causes and contributing factors, and treatment and management options.

Key Takeaways:

• Excoriation disorder involves compulsive and repetitive skin picking, often leading to skin damage.
• Skin picking may be used to deal with negative emotions or to relieve urges, while others may engage in skin picking automatically (without realizing they’re doing it).
• While it is considered a long-term condition, symptoms can often be reduced or eliminated with therapy and/or medication. Early intervention significantly increases the odds of better outcomes.

Understanding Excoriation Disorder

Excoriation disorder, also referred to as skin-picking disorder or dermatillomania, is a mental disorder characterized by repetitive and compulsive skin-picking. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), excoriation disorder is listed within the obsessive-compulsive and related disorders.

Individuals with excoriation disorder feel a very strong urge to pick their skin, and often feel significant temporary relief after picking. In turn, this makes it very hard to stop. ^[1]

As a result, even though many individuals with this disorder have a strong desire to stop their behaviors and often engage in deliberate attempts to stop, they are often unable to successfully do so. ^[1]

How Common is It?

Excoriation disorder affects approximately 2% of the population at any given time, and around 5% of all individuals will be affected at some point in their life. A much higher percentage of people pick their skin from time to time, but their behaviors aren’t persistent or severe enough to be diagnosed as an actual disorder. ^{[1] [2]}

Who Does it Affect?

Around 55% of individuals with excoriation disorder are women, so it is a bit more common in women than men. The onset of excoriation disorder often occurs in adolescence or middle adulthood, with peak onset at age 12-13. However, it can develop at any age. ^[1]

It is also more likely to occur in individuals with acne, eczema, or other skin conditions, in part because these may act as initial triggers for skin picking. ^[1]

Symptoms

The primary symptom of excoriation disorder is compulsive and repetitive skin-picking, which means that individuals pick at their skin due to a very strong impulse or urge. People with this disorder may pick skin from various parts of their body, including: ^{[2] [3] [4]}

• Face
• Head
• Cuticles
• Back
• Arms
• Legs
• Hands
• Feet

In addition to literal picking, other behaviors are classified as skin picking too, such as:

• Scratching
• Rubbing
• Digging
• Squeezing

Individuals with excoriation disorder most often pick with their fingers or fingernails, but may also use other methods, such as biting with their teeth or the use of tweezers or scissors. ^{[2] [3]}

Due to the effects of skin picking, symptoms also include skin damage, such as:

• Scarring
• Irritation
• Redness
• Dark spots
• Bruising

Is Excoriation Disorder the Same as Trichotillomania?

Excoriation disorder is not the same as trichotillomania. While both of these disorders involve body-focused repetitive behaviors, excoriation disorder refers to compulsive skin picking, whereas trichotillomania refers to compulsive hair-pulling. Therefore, they affect different parts of the body. ^[1]

Causes of Excoriation Disorder

The exact causes of excoriation disorder aren’t fully clear, although it likely involves a combination of genetic, biological, environmental, and psychological factors.

Regarding genetics, individuals with excoriation disorder are much more likely to have at least one first-degree family member with this condition. ^[2]

There are also several possible biological causes, particularly with brain function. Individuals with excoriation disorder have been shown to have abnormalities in key brain regions that are related to impulse control, emotion regulation, habit generation, and general cognitive functioning. They may also have a diminished pain response. ^[1]

Psychological factors may also play into the development of excoriation disorder. Skin picking may initially result as a way to cope with stress, anxiety, boredom, or other unpleasant emotions, which could lead to habit formation over time. This is particularly important, given that individuals with this disorder also generally have greater difficulties with emotional regulation. ^{[1] [2] [3]}

Finally, skin issues, such as acne or eczema, may act as initial drivers for skin picking. In some people, these behaviors can persist even after the skin issues resolve. ^[5]

Risks and Complications

Excoriation disorder involves several risks and complications. Firstly, it can cause skin damage over time, possibly resulting in scars, bruising, sores, infections, and other issues. Severe cases of skin damage may require surgery. ^{[2] [3]}

Dermatillomania can also contribute to psychological issues, such as depression and anxiety, as well as shame and guilt. These often occur in a cycle, which can be very hard to break out of. ^{[2] [3]}

Individuals with excoriation disorder also have relatively high rates of comorbid mental health concerns. Rates of obsessive-compulsive disorder (OCD), body dysmorphia, and trichotillomania are higher in this disorder compared to the general population. ^{[4] [5]}

In addition, one study found the following rates for mental health comorbidities in individuals with excoriation disorder: ^[6]

• Generalized anxiety disorder: 63.4%
• Depression: 53.1%
• Panic disorder: 27.7%

Frequent and compulsive skin picking can also interfere with school, work, relationships, socialization, and other important life functions and obligations. ^{[2] [3]}

Prevention

Prevention isn’t guaranteed in all individuals, especially because the exact causes aren’t known and often vary from person to person. However, there are things you can do to lower your risk of developing it, such as:

• Getting help for depression, anxiety, or other mental health issues
• Stress management and emotional regulation techniques
• Seeking treatment as early as possible if you notice symptoms

Treatment Options

Treatments for excoriation disorder often include psychotherapy and/or medication. Other treatments, such as medical interventions for skin damage and treatment for comorbid mental health disorders, may also be implemented, depending on each person’s needs and symptoms.

When diagnosed early and treated professionally, there is a much higher likelihood that you will experience significant symptom reduction. ONe study found that 87% of individuals who were treated professionally for excoriation disorder experienced reduced symptoms. ^[5]

Psychotherapy

Several forms of psychotherapy are used for treating excoriation disorder, such as habit reversal therapy (HRT), cognitive behavioral therapy (CBT), and acceptance and commitment therapy (ACT).

HRT consists of several core aspects to lead to healthier behaviors. These include: ^[1]

• Self-monitoring: Tracking symptoms of skin picking
• Awareness training: Becoming more aware of skin picking, including specific times, triggers, etc.
• Competing response training: Implementation of healthier alternatives to skin picking when urges are strong
• Stimulus control: Modifying the environment to reduce or eliminate skin-picking triggers

CBT focuses on identifying, challenging, and replacing maladaptive thoughts and behaviors that contribute to skin-picking behaviors. It also often involves the development of coping strategies and skills, such as mindfulness and stress management.

ACT helps individuals to first accept their compulsions to pick their skin as normal behavior. From there, individuals identify their goals and personal values and commit to stay motivated and work towards those goals, while also using mindfulness and other techniques to cope with stress and other triggers. ^[4]

Medication

Several medications may be used to treat excoriation disorder, such as: ^{[1] [2] [3] [4]}

• Selective-serotonin reuptake inhibitors (SSRIs), which are a group of antidepressants:
• e.g. fluoxetine, fluvoxamine, escitalopram
• Anticonvulsants, such as lamotrigine
• Tricyclic antidepressants, such as clomipramine
• Antipsychotics, such as olanzapine
• N-Acetyl Cysteine (NAC)

Other Treatments

Skin damage that often occurs in excoriation disorder may be treated with topical gels, creams, ointments, or wound dressings. More severe cases may require surgery or other medical interventions.

Another important part of treatment is addressing any comorbid mental disorders, such as anxiety and depression. These are often treated with antidepressants/anti-anxiety medications and/or psychotherapy.

Long-Term Care

Excoriation disorder is a lifelong condition. This is because, even if your symptoms resolve at a given point, you are considered in remission and not cured, due to the risk of relapse. ^[2]

Therefore, it’s important to take a long-term approach when dealing with this disorder. To do this, you can implement specific steps, such as: ^{[1] [2]}

• Regular medical visits and check-ups, as recommended
• Take any existing medications as prescribed
• Continue with therapy
• Even if symptoms are getting better, it’s best to stay with a long-term approach
• Avoid triggers as much as possible
• Stress management techniques, such as meditation, deep breathing, yoga, etc.
• Seek support from trusted family and friends

Author

Jack Cincotta

Jack Cincotta holds a M.S. degree in Psychology. He is also a board-certified holistic health practitioner through AADP and an AFPA-certified holistic health coach and nutritionist.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

Kaye SmithPhD

Dr. Smith is a behavioral health coach, clinician, writer, and educator with over 15 years of experience in psychotherapy, coaching, teaching, and writing.

Activity History - Medically reviewed on April 1, 2026 and last checked on March 19, 2026