From the Guidelines
Dermatillomania, or skin picking disorder, can be effectively treated with a combination of behavioral therapies, including habit reversal therapy and attention training 1.
Treatment Options
- Habit reversal therapy: involves awareness training and the use of competing responses, such as making a fist rather than picking, to tackle skin-picking behaviors that have a habitual quality 1.
- Attention training: can be used to develop greater attentional control and reduce self-focused attention by systematically training individuals to focus attention externally, such as on sounds in the room or colors in a picture 1.
Additional Considerations
- Relapse prevention: is crucial in the treatment of dermatillomania, and involves developing a plan for building on treatment gains, identifying potential triggers for a lapse or relapse, and creating an action plan for tackling any symptoms that re-emerge in the future 1.
- Behavioral therapies can be provided by coaches with minimal clinical qualifications or therapists with limited experience, highlighting the potential scalability of this approach 1. It is essential to note that while pharmacological interventions may also be used in the treatment of dermatillomania, the provided evidence primarily supports the use of behavioral therapies, such as habit reversal therapy and attention training 1.
From the Research
Treatment Options for Dermatillomania (Skin Picking Disorder)
The treatment options for dermatillomania (skin picking disorder) can be categorized into behavioral and pharmacological interventions.
- Behavioral treatments:
- Habit reversal training (HRT) and stimulus control are first-line behavioral treatments that can be used in cases of all severity levels 2
- 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 2
- Cognitive-behavioral therapy (including habit reversal or acceptance-enhanced behavior therapy) is also recommended 3
- Pharmacological treatments:
- N-acetylcysteine (NAC) should be considered for all severity levels and styles given its moderate gain/low side effect profile 2
- Selective serotonin reuptake inhibitors (SSRIs) can be considered in cases with significant comorbidities or previous behavioral/NAC treatment failure 2, 4, 5
- Other pharmacologic interventions, such as glutamatergic agents, have been tried with variable success 4
- Paroxetine treatment has been shown to be effective in a case report of a patient with skin picking disorder and obsessive-compulsive disorder (OCD) with depressive features 5
Interdisciplinary Approach
An interdisciplinary team approach, consisting of a liaison with psychiatry, is recommended in the management of skin picking disorder 4. The specific roles of dermatologist and psychiatrist are discussed in detail, highlighting the importance of collaboration in treating this disorder.
Effectiveness of Treatments
Research suggests that behavioral treatments, such as habit reversal training, demonstrate significant benefits compared to inactive control conditions 6. However, there is limited evidence to support the efficacy of pharmacological treatments, including SSRIs, in treating skin picking disorder 6. Further research is needed to develop larger placebo-controlled randomized controlled trials to examine the efficacy of novel pharmacological agents and improve accessibility of behavioral treatments with demonstrated efficacy for skin picking disorder 6.