What are the treatment options for dermatillomania (skin picking disorder)?

From the Guidelines

Dermatillomania, or skin picking disorder, can be effectively treated with a combination of therapy, particularly habit reversal training, and medication, prioritizing cognitive-behavioral therapy (CBT) as the first-line treatment. The treatment approach should focus on teaching patients to recognize triggers and develop alternative responses, as outlined in the study by 1. Key components of therapy include:

• Attention training to develop greater attentional control and reduce self-focused attention
• Habit reversal therapy to tackle skin-picking behaviors with a habitual quality, involving awareness training and competing responses
• Relapse prevention strategies, such as identifying potential triggers, warning signs of relapse, and developing an action plan for tackling re-emerging symptoms

Medication options, such as selective serotonin reuptake inhibitors (SSRIs), may also be considered, as discussed in the context of obsessive-compulsive disorder treatment by 1. However, the most recent and highest quality study, 1, emphasizes the importance of therapy, particularly habit reversal training, in treating dermatillomania. Practical self-help strategies, such as keeping nails short, using fidget toys, and tracking triggers, can also support treatment. It is essential to address both the physical behavior and underlying psychological factors, typically requiring several months of consistent effort before significant improvement occurs. The treatment approach should prioritize the patient's preferences, access to trained clinicians, and the presence of comorbid conditions, as highlighted by 1.

From the Research

Treatment Options for Dermatillomania (Skin Picking Disorder)

• Cognitive-behavioral therapy (CBT), particularly habit-reversal therapy and acceptance and commitment therapy, have shown promise in treating dermatillomania 2, 3, 4, 5
• Pharmacological interventions, such as:
  • Selective serotonin reuptake inhibitors (SSRIs) 2, 3, 6
  • Serotonin-norepinephrine reuptake inhibitors 2
  • Antipsychotics 2, 6
  • Glutaminergic-modulating agents 2
  • N-acetylcysteine 2, 6
  • Mirtazapine 6
• Non-pharmacological treatments, including:
  • Behavioral therapy 3
  • Habit reversal exercises 3
  • Support groups 3
  • Repetitive transcranial magnetic stimulation 5
  • Online self-help modules 5
  • Expressive writing 5
• A multipronged approach, including treatment of underlying psychiatric illness, treatment for pruritus, and topical treatment of lesions, is recommended 3, 4