One of our clients with Skin Picking Disorder ( aka Dermatillomania ) recently wrote this essay about her long-standing issues with her dermatologist. She has asked to remain anonymous.
A skin picker’s relationship with their dermatologist is, to put it lightly, fraught.
It’s a vicious cycle:
The skin picker picks their skin.
The skin picker is unhappy with the way their skin looks.
The skin picker goes to the dermatologist.
The dermatologist, with the medical authority of a white lab coat, tells the picker:
“Don’t pick.”
The picker spirals into shame.
Next time there is a problem, the picker avoids the dermatologist.
Then, maybe, the picker’s picking results in an infection.
The picker remembers:
“Don’t pick.”
“Don’t pick.”
“Don’t pick.”
Those words ring in the picker’s head.
No way is the picker going back there.
All that waits at the dermatologist is more humiliation.
The picker puts it off.
Keeps picking.
So the infection gets worse.
This leads to more stress.
Which leads to more picking.
And on and on, down a deep dark hole of guilt and anxiety.
Not that I’ve ever done this. Of course not. A competent, intelligent person like me would never do something so irrational. But that’s what excoriation disorder does: it makes an otherwise rational person afraid of someone as benign as a dermatologist. I mean, these are the people to administer Botox to half of Los Angeles. How scary can they be?
Oh, by the way: I have done this. Many times. But I recently had the best dermatologist experience of my god-for-picking life.
It started with a couple of pus-filled whiteheads in my armpit. This was abnormal, but it was only a couple little guys so I didn’t think much of it. And naturally, I popped them. More sprouted. I popped those. They stung, they itched, they burned, and I kept popping them anyway. For every one I popped, three new ones would appear. I went on like this for weeks, avoiding tank tops and, of course, the dermatologist.
But I was in the middle of Cognitive Behavioral Therapy (CBT), working on being proactive about my picking and my health. So I bit the bullet and made an appointment. Then, I prepared for battle. I was not going to let this acne-slayer defeat me as I had been so many times before. I was strong, I was ready, and I was gonna go get those antibiotics, damn it!
It only took two changes to turn my appointment from a hell-scape to, you know, a regular doctor’s appointment:
- On my medical intake forms, I confessed that I was a skin picker. This wasn’t easy. I’d been accustomed to writing something vague about anxiety, glossing over the truth. But this time, I wrote something along the lines of “I struggle with compulsive skin picking / excoriation disorder / dermatillomania and have for years. I am currently undergoing CBT for it.” Boom. Done. Writing it down felt like the down coat in the blizzard I was about to weather.
- I brought up my skin picking first thing in the appointment. When the doctor asked me why I had made the appointment, I responded right away with something like: “I struggle with skin picking disorder. It’s something I’m in therapy to help, but I need you to know this: I know picking my skin is bad. I am trying to stop. But it is inevitably going to happen.”
To my doctor’s credit, she really listened to me. And because I spoke up, she was able to shape my treatment around the reality of my situation, rather than a wishful version of it. She treated me, not a person who could hear “don’t pick” and just stop picking.
In the past, I would omit the elements of my circumstance that I felt embarrassed about. And with nothing else to go on, the doctor would prescribe based on the story I told them. But this time I did not hold back. I told the truth, the whole truth, and nothing but the truth. And because my dermatologist had all of the information, she was able to prescribe medication that helped my actual situation, not the situation I wished I could be in if I wasn’t a picker in the first place.
It’s shocking that dermatologists are so uneducated about this disorder. I mean, all they need to do is a little googling. Come on! But given this fact, it’s up to the picker to do the work. My armpits (and my mind) are now free and clear because I educated them. I left the office feeling powerful. In the past, the dermatologist was guaranteed to send me into a spiral of shame. But this time was different. No spiral. No shame. This time, I came prepared, and it paid off.
You can click here to learn more about Dermatillomania / Skin Picking Disorder and its treatment.
You can also click here to read our article “Excoriation (Skin Picking) Disorder, aka Dermatillomania”.
•The OCD Center of Los Angeles is a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions, including Hoarding. In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.
44 Comments
Thank you for this. I can relate on so many levels. I am continuously being told “don’t pick”. It’s not that easy and makes it that much more stressful. I need to find a treatment/dermatologist in South Africa.
Hi Shelley,
Thanks for your comment. I do not know of any dermatologists in South Africa, but hopefully you will find one who is sympathetic to your struggle. As for treatment for Skin Picking Disorder, if you are amenable to online therapy, you can reach us via our website at title=”Online therapy for Skin Picking Disorder” https://ocdla.com/telephone-online-therapy-ocd-anxiety/.
I can almost guarantee I have the worst arm/chest acne on the planet. It has hindered my existence for many years. I am now 34 and it has never been worse. I look at homeless people’s who have better skin and think wow why does this happen to me?
Ryan,
I don’t know if you have the “worst acne on the planet”, but I do know that you can get help. A good dermatologist should be able to help with acne and scarring, and a therapist who specializes in treating Dermatillomania should be able to help with any related skin picking.
This is a very cogent essay that applied to most behavioral issues and the doctor. My skin picking is mild and confined to fingernail cuticles, but I feel the same way about weight. I finally had a talk with my doctor very similar to this, and I’m no longer weighed at the doctor, provided I can discuss what I’m doing to manage it.
Hi Katnap,
Thanks for commenting. I agree that the principles of open communication noted in the essay apply to most behavioral issues that require medical intervention. I’m glad to hear that you have been able to discuss your weight issues with your physician in a manner that results in a better treatment experience for you.
I can relate. I won’t even go to a dermatologist, and I hate going to doctors. I avoid them as much as absolutely possible.
Hi Melissa,
I know many other people with Dermatillomania / Skin Picking Disorder can also relate to this essay. Hopefully this article can motivate you to seek treatment if needed, and to follow the author’s suggestions about openly communicating with your physician about your picking. Take care.
Great article, got a Medicare approved branch in Sacramento?
Hi Alyson,
We have five offices, but all are in Southern California. I am guessing you can find treatment in Sacramento or nearby, but if not, we can be reached via our website at https://ocdla.com/.
Great article. I wish I had a dollar for every time someone told me to stop picking or don’t pick. Is there anyone in the Little Rock area that you recommend. Mine is confined to my cuticles and I’ve done it for 35 years! I have a teenage son that has done it since he was about 8. We could use some help.
Hi Jane,
Many of our clients are so frustrated that the most common response they hear from dermatologists is “don’t pick”. Unfortunately, this sort of unhelpful response is common amongst all doctors and psychotherapists, most of whom just don’t understand this condition at all.
For treatment in the Little Rock area, I encourage you to visit the website of the TLC Foundation for Body Focused Repetitive Behaviors at https://www.bfrb.org/.
Good article. Thanks for sharing. As a psychologically minded dermatologist I agree that core communication skills are important. Linking with clinical psychology is desirable and there is a large role for self-directed therapy using on-line resources.
Hi Andy,
It is GREAT to hear from a dermatologist on here. I completely agree with you that patient-doctor communication is critical.
I pick at my cuticles all the time and can spend an hour+ in front of he mirror extracting from every pore on my face. I have never gone to seek help. Any recommendations near 96097 zip code? It was nice to hear I’m not alone….
Hi Katherine,
You are not even close to alone, as cuticle picking is a fairly common experience for people with Dermatillomania. However, you live in a fairly rural area, and as such, you may need to go some distance to find a therapist who specializes in treating Dermatillomania.
That post was like reading my diary: thank you so much!!!
I have been told not to pick, over and over. The red bumps itch and itch; then the scabs itch and itch.
Recently, however, the dental hygienist recommended a sulfate-free toothpaste to assist with my irritated and bleeding gums. I decided to experiment with sulfate-free products–shampoo and body wash, in particular.
My skin is healing, and as it is, the urge for picking is dissapating.
Pat,
I have not heard of this specific issue with sulfates, but we have had many clients report that certain cleansers irritate their skin, which in turn leads to an increase in picking. I am really happy to hear that this fairly simple change is helping you, and I thank you for bringing this to attention of our staff, and to readers of this blog.
I have not heard about this specific issue either, but it kind of makes sense. I switched to sulfate-free hair products years ago because they strip my hair of its natural oils, causing frizziness and split ends. I suffer from picking at KP on my arms and legs, which is exacerbated by dry skin due to cold weather, hot showers, etc., so to me it follows that a sulfate-free cleanser would help skin on face and body retain natural sebum and perhaps not be so dried out. But it probably still needs to be paired with a good chemical exfoliant, at least for me and my KP situation.
Thanks for the article and for the kind and helpful administering in the comments section!
This has helped me out so much! Do you have anyone in the Chicago burbs, IL area?
Felicia,
I encourage you to visit the TLC Foundation for Body Focused Repetitive Behaviors at http://www.bfrb.org/. They have a searchable database of treatment specialists.
This was wonderful and right on in describing doctors’ lack of education and knowledge on how to treat such a patient. For me the issue has been ingrown hairs and emotional abuse that triggers the picking. My dream is going to a center like yours that not only supplies therapists but also dermatologists and other doctors who specialize in treating scars and offering laser hair removal for patients who would come in with scars from dermatillomania. Although I’ve spoken to a therapist about the skin picking, nothing would be more healing than getting the scars treated by a caring compassionate dr. Who is trained to treat patients with dermatillomania. It would be great to have a one stop shop type center you could go to for both therapy and healing of scars.
Marie,
Thanks for your comments. Unfortunately, I know of no “one stop shop” anywhere in the world that focuses on combining psychotherapy, dermatology, and laser hair removal for skin picking disorder.
Great essay! I totally relate and not only feel shameful for picking my skin, but am too embarrassed to wear shorts because of the scarring on my lower legs! I think my trigger is stress. My skin itches intensely. I scratch and scratch and scratch until my skin is scratched off and scabs over. I live in an area with very hard mineralized water and this started 4 yrs ago when we moved in our house. My derm, DO, and allergist told me the itching is all in my head. They made me feel completely defeated. I’ve tried so many OTC tx but to no avail. I took a course of Cipro 500 mg PO X 10 days and my skin is mostly cleared up. I also use an antibacterial soap daily. Although my itching is mostly gone, my question is what to do about the excessive scarring?
Terre,
A few thoughts…
Many of our clients report that stress triggers an increase in their picking.
I know of no OTC products that control skin picking, though there is preliminary research that has suggested that the amino acid N-acetylcysteine (NAC) may help.
Cipro is an antibiotic that treats infection, but it does not treat the issue of skin picking itself. And when infection is cleared, I can imagine that itchiness could decrease.
You should discuss excessive scarring concerns with your dermatologist.
I really like this article. I feel hopeless with my skin picking. I feel like a doctor can’t do anything for me because the obsession has just taken over my ability to take control over the constant cycle it has become a vicious routine
Natalie,
Unfortunately, you are correct. Doctors are unlikely to be able to help with Skin Picking Disorder, as it is a psychological issue, not a medical issue. It only becomes a medical issue if one needs to medically manage the consequences of the picking. But you can learn to respond far more effectively to the urge to pick by getting into treatment with a therapist who specializes in treating Skin Picking Disorder.
I have never thought of seeing a dermatologist for my skin picking. My psychiatrist tells me there is nothing that can be done to help me. He suggested wearing gloves. I did try it. Dumb idea really, I just take the gloves off. Thanks to the writer for sharing. Maybe it is something I should consider.
Ann,
I don’t think the author was suggesting that she was seeing a dermatologist to treat her for skin picking per se, but rather to address the consequences of her skin picking (i.e., scarring, etc). In fact, she notes a long history of avoiding dermatologists because of her skin picking, and of not acknowledging her skin picking on those occasions when she went to dermatologist. That is the jumping-off point for the entire article.
Nonetheless, she has a dermatologist, as do many people, including those with and without Dermatillomania. And for those struggling with this condition, dermatologist visits often focus on treating the consequences of skin picking, but not the picking itself. Dermatologists do not treat skin picking, as it is a psychological / behavioral issue. Dermatologists treat medical conditions, including those that arise as a result of skin picking.
As for wearing gloves, this is actually a common and very good suggestion, especially for those who have unconscious picking habits or even pick in their sleep. Yes, one can easily remove the gloves, but the ultimate goal of treatment is to learn to tolerate the urge to pick without actually picking. Wearing gloves can be conceptualized as being like using training wheels when learning to ride a bike – something that is used as one is developing a new skill.
I myself suffer from skin picking anywhere on my body but mostly my face I sit for hrs picking at my face and every little black head. I make it so sore and red and infected but don’t know of any good dermatologist to go to around me that takes medicare. If you could help me find a good one around here that would help 35570.. thanks so much!
Penelope,
The zip code you provide indicates that you live in rural Alabama, and you are unlikely to find a therapist who specializes in treating Dermatillomania anywhere near you. However, Alabama is one of nine states in which we can provide online therapy. If this is of interest to you, please reach out to us via our contact page at https://ocdla.com/contactus/.
This is an odd piece of advice and may not work for all, but it is working for me. I hate the feeling of bumps or scabs on my skin and can not stop from picking at them. Additionally, I have an itchy rash that easily forms scabs. Itch, scratch, bleed, pick. It is the depressing story of my life. Recently, I got gel nails. They are thick and rounded on the ends and it is next to impossible for me to pick with them. My scabs are healing and I’m slowly, over time, losing the desire to pick because it is totally unproductive with gel nails. I’m on my 2nd manicure and the $25 every 2 weeks is worth it if my skin can heal. Again, I’m not sure if this will help others, but it seems to be helping me. Good luck everyone.
Barb,
Actually, this is a great piece of advice. We often suggest to clients with Dermatillomania that they try gel nails or acrylics. This is not a solution for everybody, but for some this incredibly simple, inexpensive option makes a world of difference in their skin picking for the exact reason you mention – the artificial nails greatly diminish the ability to easily pick. This approach also works for some with Trichotillomania. Thanks for sharing this!
I, too, was glad to read this article, because I know I’m not alone in my frustration with my habit. I’m an intelligent, insightful 63-year-old woman (with a much younger outlook! ☺) and have struggled with picking for most of my life. Started with nail-biting (age 5), which I still do, unless I have acrylics or gels in place. Even then, I can’t bite my nails, but I pick or cut my cuticles, and I STILL pick-pick-pick because my “weapon of choice” is my cuticle cutter! Ever hear the term “Hurts So Good”? I still haven’t figured out my triggers, but I just know that I can’t stand the feel of a scab (mostly arms/legs/feet), or a teeny bump on my face or torso. It HAS to come off. I am so scarred up…it’s embarrassing. If I’m somewhere without my cuticle cutters, and I locate something that has to be “removed”, I find anything that works. (paper clip, tweezer, knife, etc). I think I’m hopeless…..PLUS I am going to buy stock in BandAids. At least I could get something positive out of this mess.
Hi Joanne,
Unfortunately, your experience of feeling a powerful need to pick is common. What I see however is that nowhere in your comment do you mention anything about seeking treatment for your picking. Effective treatment is available, though admittedly difficult to find. I encourage you to seek out a therapist who actually specializes in treating Dermatillomania.
Oh, I relate so much.
I’ve been struggling with this for some years now. But I don’t know who to visit first, a psychologist or a dermatologist. I know I need both. It’s harder when in my country, Mexico, this is called “a phase”, a “bad habit”. We all know it’s way more than that.
I need help
Melissa,
I don’t think it matters whether you see a dermatologist of psychotherapist first. They will be addressing different issues. A dermatologist will deal with your skin, and a psychotherapist will deal with your thoughts, feelings, and behaviors.
I encourage you to schedule an appointment with a dermatologist and a psychotherapist.
My boyfriend tells me not to pick. We have half hour discussions over it. He’s gotten angry about it because he does not like me hurting myself. I don’t see it as hurting myself (even though I bleed sometimes and have caused scarring from picking scabs for weeks or months at a time) and I’ve actually been picking more since he’s been on my back about it. Part of it is spite. Part of it general stress. Mostly it’s satisfying and soothing for me so I keep doing it when I’m alone and when I’m too distracted to control myself in public. I saw a comment about getting gel nails to basically declaw youreself…I might consider that while I get myself in line for CBT.
Wonderful article, and I’m glad I subscribed to this site. =)
Michelle,
A few thoughts…
You say you don’t see your picking as hurtful to yourself, yet you report that you bleed and have caused scaring from picking for weeks or even months. I’m not sure how you see that as not hurtful. Any behavior you do that draws blood and causes scarring sounds pretty hurtful to me.
Your boyfriend has his heart in the right place, but getting angry at you is unlikely to get you to stop picking. That said, picking out of “spite” towards him only hurts you.
You describe your picking as “satisfying and soothing”. We hear that from the majority of people who come to us for treatment of Dermatillomania. In fact, the sense of gratification you are experiencing is the single most common reason that people pick, and the single biggest impediment to effective treatment. After all, who wants to give up something that feels good (even if the consequences are bloody scabs and permanent scarring).
Yes, gel nails can be very effective for some people. I encourage you to give them a try. But the tools you learn in CBT are the best option for long-term management of your urge to pick.
I’ve never attempted to visit a dermatologist. I am heavy picker. My arms are scarred and my legs and stomach are areas I try to go to in order to avoid my arms looking so unsightly. Family and friends tell me constantly to stop. I try to explain but they don’t get it. I have resorted to saying it’s like my comfy blanket that toddlers have. I pick when I’m nervous, bored, anxious, scared…almost any emotion. Picking offers me an escape from whatever is uncomfortable. I’m in Tulsa, OK and I’m clueless where to seek help.
Hi Rachael,
Your story is a common one. Many of our clients report that they resort to picking at less visible areas such as their legs and torso. Also, many tell us of their frustration in dealing with family members who simply don’t grasp how difficult it is for those with Dermatillomania to to resist the urge to pick.
That said, you can learn to resist the urge. Unfortunately, you are unlikely to find any Dermatillomania treatment specialists near you in Tulsa. I encourage you to consider looking outside of your area, as that will more likely lead to effective treatment. If intensive treatment is an option for you, please feel free to contact us for treatment.
This article and the one on dermatillomania has helped me so much. I’ve had this since I was 4, it’s been 11 years, and it just gets worse and worse every year. I’ve never purchased a tank top, strapless dress, or short sleeved dress. I always thought it was my fault for not controlling myself, but I could never stop picking, and now I know why, so thanks! It’s spread from a small patch to 100% of my arms and now on my legs too. A while ago, I had two doctors at separate clinics tell me I had keratosis pilaris. I want to get help, but my parents are getting a divorce and my mom has no income, so we can’t afford to go see a doctor. Is there an OTC drug I could get, some kind of antidepressant or something? My zipcode is 37067, btw, so even if we could afford treatment, I doubt there would be anyone in Nashville or Williamson County who could help.
Dora,
Unfortunately, many physicians are so uninformed about Dermatillomania that they don’t even think about it when assessing and diagnosing patients with skin conditions. And for some people, keratosis pilaris does in fact play a role in their picking. It is crucial that you specifically explain to your physician that your scabs are the result of picking.
I don’t think you are likely to find a prescription or OTC drug that magically makes you stop picking. The better solution is to learn how to more effectively respond to your urges to pick, and the best way to do that is to seek treatment with a therapist who specializes in treating Dermatillomania with Cognitive Behavioral Therapy (CBT). You may be able to find a specialist via the searchable database of the TLC Foundation for Body Focused Repetitive Behaviors (BFRBs).