What are the treatment options for skin excoriation disorder, also known as dermatillomania (skin picking disorder)?

From the Guidelines

Habit reversal therapy is the most effective treatment for skin excoriation disorder, as it helps patients recognize triggers for picking, develop competing responses, and build awareness of the behavior. 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 techniques in tackling skin-picking behaviors. The study suggests that habit reversal therapy can be used to develop greater attentional control and reduce self-focussed attention, ultimately leading to a reduction in skin-picking behaviors.

Some key components of habit reversal therapy include:

• Awareness training to help patients recognize their skin-picking behaviors
• Competing responses, such as making a fist rather than picking, to help patients manage their urges
• Attention training to help patients develop greater attentional control and reduce self-focussed attention These techniques can be used in conjunction with other therapies, such as cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT), to provide a comprehensive treatment plan for skin excoriation disorder.

In addition to habit reversal therapy, other treatments such as selective serotonin reuptake inhibitors (SSRIs) and N-acetylcysteine (NAC) may be beneficial in managing skin excoriation disorder. However, habit reversal therapy is the most effective treatment, and should be considered as the first-line treatment for this condition, as supported by the study published in 2024 1.

From the Research

Treatment Options for Skin Excoriation Disorder

• Cognitive-behavioral therapy, particularly habit-reversal therapy and acceptance and commitment therapy, have shown promise in treating skin excoriation disorder 2, 3, 4
• Various pharmacological interventions have been described to treat this condition, including:
  • Selective serotonin reuptake inhibitors (SSRIs) 2, 3, 5, 4
  • Serotonin-norepinephrine reuptake inhibitors 2
  • Antipsychotics 2, 5
  • Glutaminergic-modulating agents 2, 3
  • N-acetylcysteine (NAC) 2, 4
  • Naltrexone, including low-dose naltrexone (LDN) 5, 6
• A multidisciplinary approach, including a liaison with psychiatry, is important in the management of skin excoriation disorder 3
• Habit reversal training (HRT) and stimulus control are first-line behavioral treatments that can be used in cases of all severity levels 4
• Acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) can be employed to augment HRT/stimulus control, especially when negative emotions trigger the picking behavior 4