What is the treatment for psychogenic skin picking, also known as dermatillomania (Excoriation Disorder)?

From the Guidelines

The most effective treatment for psychogenic skin picking is habit reversal therapy, which involves awareness training and the use of competing responses to reduce skin-picking behaviors. This approach is supported by recent studies, such as the one published in the Journal of Child Psychology and Psychiatry and Allied Disciplines in 2024 1, which highlights the potential benefits of habit reversal therapy in tackling skin-picking behaviors.

Some key techniques used in habit reversal therapy include:

• Awareness training to recognize triggers and patterns of skin-picking behavior
• Competing responses, such as making a fist rather than picking, to substitute healthier behaviors
• Attention training to develop greater attentional control and reduce self-focused attention

Additionally, relapse prevention strategies are crucial in maintaining treatment gains, including:

• Developing a plan for building on treatment gains
• Identifying potential triggers for a lapse or relapse
• Identifying 'warning signs' of relapse
• Action plan for tackling any symptoms that re-emerge in the future
• Identifying sources of support if a lapse or relapse were to occur, as noted in the study by 1.

It's worth noting that these treatments can be provided by coaches with minimal levels of support, highlighting the potential scalability of this approach, as demonstrated by studies such as Wilhelm et al. (2022) and Enander et al. (2016), which are referenced in the study by 1. Overall, a comprehensive treatment plan that incorporates habit reversal therapy and relapse prevention strategies can help individuals with psychogenic skin picking to manage their symptoms and improve their quality of life.

From the Research

Treatment Options for Psychogenic Skin Picking

• Cognitive-behavioral therapy, particularly habit-reversal therapy and acceptance and commitment therapy, have shown promise in treating psychogenic skin picking 2
• Various pharmacological interventions have been described to treat this condition, including:
  • Selective serotonin reuptake inhibitors (SSRIs) 2, 3, 4
  • Serotonin-norepinephrine reuptake inhibitors 2
  • Antipsychotics 2, 3
  • Glutaminergic-modulating agents 2
  • N-acetylcysteine 2
• Behavioral therapy, habit reversal exercises, and support groups have also been found to be helpful and well-tolerated amongst patients suffering from psychogenic skin picking 4
• A multicomponent programme consisting of self-monitoring, recording of episodes of scratching, and procedures that produce alternative responses to scratching has been found to be effective in case reports 3
• An 'eclectic' psychotherapy programme with insight-oriented and behavioural components has also been found to be effective in case reports 3
• Psychological counseling has been used to treat dermatillomania in patients undergoing orthodontic treatment 5

Important Considerations

• Treatment of psychogenic skin picking should include treatment of the underlying psychiatric illness, treatment for pruritus, and topical treatment of the lesions 4
• SSRIs have been found to be the most effective in treating the psychiatric component of psychogenic skin picking, but may also induce or aggravate pathological skin-picking behaviour in some cases 6