It's eleven at night and you go into the bathroom to brush your teeth. In the magnifying mirror you spot a tiny spot on your chin and think you'll sort it out in a second. Forty minutes later your face is red, there are two wounds that weren't there before and you have that feeling of having done it again. The next morning it's make-up, and a promise that it won't happen again. If this happens to you a lot, you may have dermatillomania.
It isn't vanity or a lack of willpower. It's a recognised disorder, more common than you might think, and it can be treated. In this article I'll explain what dermatillomania is, how to recognise it, why it's so hard to stop and what actually helps with skin picking.
What is dermatillomania?
Dermatillomania, which the diagnostic manuals call excoriation disorder or skin picking disorder, means picking, squeezing or scratching at your skin again and again until it's damaged, with failed attempts to stop and with distress or limitations that weigh on daily life. Medical writing has described it since the 19th century, but it only entered the DSM-5 in 2013, in the group of obsessive-compulsive and related disorders. The World Health Organization also includes it in the ICD-11, next to trichotillomania, among the body-focused repetitive behaviours.
The NHS sums it up in one simple line: you cannot stop picking at your skin. People use their fingers and nails, but also their teeth, tweezers or pins. For it to count as a disorder, the picking mustn't be caused by another medical condition, such as scabies, or by a substance.
Symptoms of dermatillomania
The core behaviour is easy to describe and hard to rein in. The person picks at spots, scabs, freckles, moles, scars or tiny bumps in the skin, often to make it "smooth" or "perfect", until there are cuts, bleeding or bruises. Other common signs are:
- Having tried many times to stop or cut down, without success.
- Spending a lot of time on it, sometimes without noticing.
- Covering the marks with make-up, long sleeves or plasters.
- Avoiding the beach, the gym or any situation where your skin is on show.
- Feeling guilty after every episode.
Many people feel a build-up of tension beforehand and relief, or even pleasure, while they pick. In a survey of 2,513 adults in the United States, between a fifth and a quarter of those who picked without any medical reason described it this way (Keuthen and colleagues, 2010). That relief is what keeps the behaviour going, and the shame that comes afterwards can trigger the next episode.
Automatic and focused dermatillomania
Researchers distinguish two styles of skin picking (Walther and colleagues, 2009). With automatic picking, your hand wanders there on its own while you read, scroll on your phone or drive, and you only notice once there's a wound. The NHS lists this among the signs: you don't always realise you're picking. With focused picking, by contrast, you do it deliberately, to get rid of a flaw or to soothe an emotion. Many people do both, and knowing which one dominates in your case helps you choose the right strategies.
Why does it happen?
There's no single cause. The NHS links it to obsessive-compulsive disorder and to trichotillomania, and highlights some common triggers:
- Boredom.
- Stress and anxiety.
- Difficult emotions, such as guilt or shame.
- Skin conditions such as acne or eczema, and any spot or blemish.
In the short term, picking works as a way of shaking off tension or an uncomfortable feeling. The trouble is that the relief doesn't last, and the cost, to your skin and your self-esteem, keeps rising.
It can start at any age, but it most often begins in adolescence (Ricketts and colleagues, 2018).
It's more common than you think
In a survey of more than 10,000 adults representative of the US population, 2.1% met the criteria for dermatillomania at the time and 3.1% had met them at some point in their lives (Grant and Chamberlain, 2020). Other studies put the figure between 1.4% and 5.4%, depending on how it's measured, and at one US university it reached 4.2% of students, with more women (5.8%) than men (2%).
Even so, it often goes unnoticed. Many people only seek help for the wounds. In a study at University Hospital Zurich of 154 patients seen in dermatology for this problem, fewer than 5% were referred to a psychologist or psychiatrist (Anzengruber and colleagues, 2018).
It also rarely comes alone. Among the people in the US study who had it at the time, 63% had generalised anxiety, 53% depression and 28% panic disorder.
Dermatillomania, acne, body dysmorphia and self-harm
Having spots or eczema doesn't rule out dermatillomania. People often have both, which is why it helps for a dermatologist to treat the skin while you work on the behaviour. The NHS explains that a GP may refer you to a dermatologist if the damage is severe or there's an underlying skin condition.
Body dysmorphia is a different case. There, the core is a preoccupation with a flaw in your appearance that others can barely see, and picking is an attempt to fix it. If you spend hours thinking about how people see you and pick to correct it, that's the angle to look at, because the treatment changes.
It isn't the same as self-harm either. People with dermatillomania aren't trying to hurt themselves, even though they end up doing so. If you pick to punish yourself or to feel pain, it needs to be treated as self-harm, and it's important to ask for help as soon as possible.
The toll on your skin and your life
The most visible effects are physical, such as cuts, bleeding, bruises, scabs that never heal because they keep being reopened, marks and scars. Wounds from dermatillomania can become infected, which is why the NHS advises keeping your skin clean and seeing a GP if a cut doesn't heal within a few days.
The other effects are less visible. Some people stop going to the beach, keep their jacket on at work, avoid intimacy or run late because they got stuck in front of the mirror. And the feeling of not being able to control something that seems so small weighs heavily.
Dermatillomania treatment
The backbone of dermatillomania treatment is psychological therapy. The NHS points to cognitive behavioural therapy, often including habit reversal training, as the most common option. A 2016 systematic review found that, of all the treatments studied, only behavioural ones clearly outperformed control groups, while trials of SSRI antidepressants or lamotrigine did not beat placebo (Schumer, Bartley and Bloch, 2016). A more recent review of drug-free treatments highlights cognitive behavioural therapy, habit reversal training and acceptance-enhanced behaviour therapy (Loftus and colleagues, 2025).
What habit reversal training involves
- Awareness. You note when you pick, where, what you were doing and what you were feeling, and you learn to catch the early signs, like your hand moving towards your face.
- A competing response. When you feel the urge, you do something for a minute that makes picking impossible, such as clenching your fists or holding an object.
- Changes to your surroundings. Getting rid of the magnifying mirror, dimming the bathroom light, keeping your nails short or putting a plaster over the area that draws you most.
- Support. Someone you trust who helps you remember the plan without acting as a guard.
In therapy we also work on what lies underneath, such as anxiety, boredom, the way you talk to yourself when you look in the mirror, and shame. Learning to notice the urge without obeying it, instead of fighting it, is also part of some of the treatments with the best results.
As for medication, several drugs have been tried. In a trial with 66 adults, 47% of those who took N-acetylcysteine for twelve weeks were much or very much improved, compared with 19% of those on placebo (Grant and colleagues, 2016). The evidence is still limited, though, and any medicine needs to be assessed and monitored by a doctor. Don't take it on your own.
How to stop picking your skin: what you can do starting today
These tips, which follow the NHS's advice, don't replace therapy, but they do help to keep dermatillomania in check:
- Keep your hands busy with a stress ball, a ring or any object you can fiddle with.
- Note when and where you pick most, and try to avoid those moments or plan for them.
- When the urge comes, hold out a little longer than last time.
- Care for your skin instead of picking it. Putting on moisturiser can be a good alternative for your hands.
- Keep your nails short and don't keep tweezers or pins within reach.
- Keep your skin clean to avoid infection.
- Tell someone you trust.
Dermatillomania in teenagers
Because it usually starts in adolescence, an age when acne is common and appearance matters a lot, it's easy to mistake dermatillomania for a passing teenage habit. If you notice your son or daughter has wounds that don't heal, spends a long time in the bathroom or covers their face, it's worth talking about it calmly.
Telling them off or repeating "leave your face alone!" doesn't help much and tends to make them hide it more. It works better to acknowledge that it's hard, offer help and have a dermatologist treat any acne while a psychologist works on the behaviour.
When to ask for help
It's worth seeing someone if:
- You can't stop picking, even when you try.
- You cause wounds that leave marks or get infected.
- It causes you distress or gets in the way of daily life.
- You spend a lot of time on it or avoid places and people to hide your skin.
If a wound doesn't heal within a few days, feels hot, oozes pus or you have a fever, see a doctor. And if at any point you think about hurting yourself or ending your life, call 024 (Spain's suicide helpline), which is free and open 24 hours a day, or 112 in an emergency.
Therapy for dermatillomania in Igualada and online
At my practice in Igualada and online, I treat dermatillomania from a cognitive behavioural approach. First we get a clear picture of your case: when you pick, where, what you feel before and after, and what you've tried so far. Then we use habit reversal training and work on the emotions that feed the behaviour, especially anxiety and shame. If needed, I'll suggest having a dermatologist check your skin. Since it belongs to the OCD-related disorders, you'll find more about how I work with this group of problems on the page about online OCD therapy. I work in Spanish and Catalan, as a health psychologist.
You don't need to have it all figured out first. Get in touch and, in a first conversation with no commitment, we'll look at how I can help.