Differential Diagnosis for Picking at Skin

• Single most likely diagnosis:
  • Dermatillomania (Skin Picking Disorder): This is a psychological condition characterized by repetitive and compulsive picking at one's skin, often resulting in skin damage. It's the most straightforward diagnosis for someone exhibiting this behavior.
• Other Likely diagnoses:
  • Anxiety or Stress: Individuals may pick at their skin as a coping mechanism for anxiety or stress, making it a common and likely cause.
  • Habit: For some, skin picking can be a deeply ingrained habit, often performed unconsciously.
  • Eczema or Dermatitis: Conditions like eczema can cause itching, leading to scratching and picking at the skin.
  • Acne: Picking at acne lesions is a common behavior, especially among adolescents and young adults.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Neurodevelopmental Disorders (e.g., Autism Spectrum Disorder): In some cases, skin picking can be a symptom of a neurodevelopmental disorder.
  • Substance Abuse: Certain substances can cause formication (a sensation of ants crawling on the skin), leading to picking.
  • Thyroid Disorders: Both hyperthyroidism and hypothyroidism can cause skin changes and itching, potentially leading to picking.
  • Diabetes: Diabetic neuropathy can cause itching and picking due to nerve damage.
• Rare diagnoses:
  • Keratosis Pilaris: A condition that causes rough patches on the skin, which might be picked at due to their texture.
  • Psychotic Disorders: In rare cases, skin picking can be associated with psychotic disorders, where the individual may have delusional beliefs about their skin.
  • Nutritional Deficiencies: Deficiencies in vitamins like B12 or minerals can cause skin changes and itching, potentially leading to picking behaviors.