What is skin picking: The causes, effects, treatment plans, and more

What is skin picking: The causes, effects, treatment plans, and more

Emotional toll

Text: Phoebe McDowell

It starts with a dry bit of skin on my thumb. Rough and protruding, it makes its presence known when I stroke my finger over it, making an OK sign. That's when I dig my fingernail in. The intensity depends entirely on what kind of day I'm having. If I'm stressed or bored, I go at it with force. My nail is a spoon and my thumb is a hardened tub of ice cream. I'm not satisfied until I make real dents. Until I feel that zinging physical sensation. On a good day, it becomes pink and sore. On a bad day it feels like it has its own pulse, weeping a deep, infernal red.

I can't quite pinpoint when it started. I don't think I knew I was doing it. Just this bit, I'd say to myself, tweezers in hand, writhing in pain, taking short, sharp intakes of breath. But of course that bit exposed a new bit that also needed prizing away. It's never ending and somehow, strangely pleasurable. On more than one occasion I've chased the skin on my thumb so far that it's reached my palm. I tuck my thumb into my hand and my hand into my sleeve. So viscerally ugly, lies of kitchen accidents or brushes with burning hair straighteners would ensue.

What is skin picking?

I'm not alone. It's estimated that dermatillomania, the repeated picking at one's skin, affects 1.4 per cent of the population. Also known as excoriation disorder, or more simply still, skin picking, it is, as consultant dermatologist Dr Alia Ahmed tells me, a body-focussed repetitive behaviour that sits under the umbrella of OCD, which also includes things like hair pulling and plucking — self-grooming activities. That figures, I feel an unending compulsion to pick, and can spend anywhere from five to thirty minutes trying to get hold of a single, miniscule bit of skin. I have tunnel vision. A tiger could stroll into the room and I wouldn't notice.


What are the causes of skin picking?

Studies link skin picking with body dysmorphia, the picking a way to try, albeit counterintuitively, to make an unsightly area of skin look better. (Hard relate, though I do not knowingly suffer from body dysmorphia). Similarly, underlying skin conditions such as acne and eczema, can cause people to pick. The thinking is that if they can remove that spot, or some surrounding skin, aesthetically, it'll look much better. Again, a means of grooming. Others claw mindlessly, out of habit. "Maybe they've seen their parents do it, and it's learned behaviour," says Dr Ahmed. OK, this also applies, because my mum (sorry mum) is a picker too. All you need to know is that she's got nine fingernails. Sounds awful when you put it like that.

Although I've never considered it a mental health problem, I didn't need an expert to tell me its link to anxiety (if you ever want to know how stressed I am, don't ask me, just look at my thumbs). Dr Ahmed's referrals for this condition during the pandemic have, by the way, increased. Go figure. Oh and it disproportionately affects women, who suffer more from body-focussed repetitive behaviour, and who interestingly, have more access to facilitative instruments such as tweezers, manicure sets, and sharp-tipped blackhead removers.

How bad can skin picking get?

Whether mine is a compulsion or a ritual, after speaking to Dr Ahmed, it's clear my case is mild. "I've seen someone who's picked a literal hole in their face," she tells me. And this disfigurement isn't even the worst. "One gentleman picked away at his scalp, while another woman peeled the skin of her breast off." In the case of the latter, it was problematic that she was sent for a skin graft, as although it improved the situation immeasurably cosmetically, they hadn't got to the root of the problem. Inevitably, she would pick it off again. "The risk of infection is huge," Dr Ahmed explains, "especially during a pandemic".

With cosmetic and emotional effects, Naomi, 31, tells me that she's often skipped social events out of shame and isolation. "I pick my lips to the point that they're streaming blood. I used to do it in the office, knowing that they were going to bleed and that I was going to feel disgustingly ashamed, but couldn't help it. I'd wrap a tissue around my finger, applying pressure to try and stop it. Someone would ask me a question and I'd be petrified I was going to have to say something. While WFH is good for my stress levels because I don't have to hide it from anyone (by this point, my flatmate is well aware), it means I don't know when to stop. Even more so than usual. I have no boundaries just as my lips, sore and bloodied, have no edges".

How to treat skin picking

Perhaps you'll find momentary solace in this (number four is real life footage of me last week). After that, assess how serious the situation really is, without dismissing or diminishing it. Is it causing you anxiety, sadness, embarrassment and/or pain? If the answer is yes to any of these, then go and see a dermatologist, preferably a psychodermatologist, like Dr Ahmed.

Solutions wise for chronic pickers, there's a lot to consider. Skin needs to be supported and kept clean to prevent infection. Then there's the pain, and the treatment, which, Dr Ahmed says, is a combined psychological and medical one. Cognitive behavioural therapy (CBT) can be used to get inside neural networks, to "help translate negative feelings into positive ones". It's a balancing act of supporting the skin and the mind. So much so that antidepressants are often prescribed. "It's not because we think they're depressed, but because it changes the chemical activity in the brain," says Dr Ahmed, who cites a study in which the over the counter drug NAC (N-acetylcysteine) was given to hair pullers, who experienced significantly reduced urges.

More casual pickers can benefit from simple techniques such as: resist the urge to pick for one minute, breathe or meditate. On the most basic level, more moisturised skin is harder to get stuck into. Any heavy duty, non perfumed will do. I'm lucky in that, despite ten years of maiming myself, I have little scarring. And strangely, instead of my skin becoming hardened, it's smooth and baby soft. Constantly repairing and regenerating itself (for that I thank it). Those that do should try Bio-Oil, or, if for hands, a cream with retinol to increase cell turnover and ameliorate scarring.

Dr Alia Ahmed, Consultant Dermatologist and GetHarley Practitioner is available to see virtually, via GetHarley, a platform that gives quick and easy access to some of Harley Street's best derms, doctors and aestheticians. Book online here.