From the Guidelines
The treatment for dermatillomania caused by stimulant use involves a multi-faceted approach addressing both the stimulant use and the skin picking behavior, with the most effective approach being a combination of cognitive behavioral therapy (CBT), particularly habit reversal training, and medication such as N-acetylcysteine (NAC) or selective serotonin reuptake inhibitors (SSRIs).
Key Considerations
- Reducing or discontinuing the stimulant medication under medical supervision is crucial, as stimulants can exacerbate compulsive behaviors 1.
- CBT, particularly habit reversal training, is effective for skin picking behavior, involving awareness training, competing response training, and stimulus control 1.
- N-acetylcysteine (NAC), typically 1200-2400 mg daily in divided doses, has shown benefit for reducing skin picking behaviors.
- Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (20-80 mg daily) or sertraline (50-200 mg daily) may help, especially if anxiety or depression are present.
Practical Strategies
- Keeping nails short
- Using fidget toys as distractions
- Applying barrier methods like bandages to affected areas
- Using skin-soothing products to reduce irritation that might trigger picking Addressing the underlying stimulant use is crucial because the neurochemical changes from stimulants, particularly increased dopamine, can intensify compulsive behaviors like skin picking by affecting reward pathways and executive function in the brain 1.
From the Research
Treatment for Dermatillomania Caused by Stimulant Use
- Dermatillomania, also known as skin picking disorder, is a condition characterized by repetitive picking of the skin, resulting in skin and soft tissue damage 2.
- The treatment for dermatillomania is a multipronged approach, including treatment of the underlying psychiatric illness, treatment for pruritus, and topical treatment of the lesions 2.
- Selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective in treating the psychiatric component of dermatillomania 2, 3, 4.
- Non-pharmacological treatments, such as cognitive behavioral therapy (CBT), habit reversal exercises, and support groups, have also been found to be helpful in treating dermatillomania 2, 5, 4.
- In cases where stimulant use is suspected to be the cause of dermatillomania, it is essential to address the underlying issue, as seen in a case report where skin picking developed after methylphenidate therapy for attention deficit hyperactivity disorder (ADHD) 6.
- N-acetylcysteine (NAC) has also been shown to be effective in treating dermatillomania, with a moderate gain and low side effect profile 5, 4.
Pharmacological Interventions
- SSRIs, such as fluoxetine, have been used to treat dermatillomania, with positive results 3, 4.
- Other pharmacological interventions, including serotonin-norepinephrine reuptake inhibitors, antipsychotics, and glutaminergic-modulating agents, have also been described in case reports and open and controlled trials 4.
- However, it is essential to note that there are currently no FDA-approved pharmacologic treatments for dermatillomania, and treatment should be individualized and based on the specific needs of the patient 5, 4.
Behavioral Therapies
- Habit reversal training (HRT) and stimulus control are first-line behavioral treatments that can be used in cases of all severity levels 5.
- Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) can be employed to augment HRT/stimulus control, especially when negative emotions trigger the skin picking behavior 5.
- Cognitive behavioral therapy (CBT) has also been shown to be effective in treating dermatillomania, particularly when combined with pharmacological interventions 2, 4.