Excoriation disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Yashasvi Aryaputra[3]

Synonyms and keywords: Compulsive skin picking; CSP; dermatillomania; neurotic excoriation; psychogenic excoriation


Excoriation disorder (also known as dermatillomania, compulsive skin picking, neurotic excoriation, psychogenic excoriation, or CSP) is an impulse control disorder and form of self-injury characterized by the repeated urge to pick at one's own skin, often to the extent that damage is caused. Excoriation disorder may be related to body dysmorphic disorder (BDD).[1]

Compulsive picking of the knuckles (via mouth) illustrating disfiguration of the distal and proximal joints of the middle and little fingers.

Sufferers of dermatillomania find skin picking to be stress relieving or gratifying, though it can still be as physically painful as it would be for a non-skin picker.

Historical Perspective

  • Lous-Anne-Jean Brocq was the first person to mention excoriation disorder on paper. She used the term in 1898 to describe a patient who uncontrollably picked their acne.


  • In some animal models, it has been shown that animals that who excessively pull their hairs have more endorphin receptors in their brain than animals who do not. Endorphin receptors enable endorphins to have an effect on the brain. If this is true for humans, people who are particularly compulsive about their repetitive habits may have more endorphin receptors in their brain as well. This may explain why sufferers get more enjoyment out of picking their scabs than others.


  • Those suffering from excoriation disorder have very damaged skin, as a result of picking at it constantly.
Skin Picking results on arms, shoulders and chest are visible. While this look can be a social disturbance, it is also a time-consuming habit.

Differential Diagnosis

Excoriation disorder must be differentiated from:

  • Neurodevelopmental disorders
  • Other disorders
  • Other medical conditions
  • Somatic symptom and related disorders
  • Substance/medication-induced disorders

Epidemiology and Demographics


  • The prevalence of excoriation (skin-picking) disorder is approximately 1,400 per 100,000 (1.4%) individuals worldwide.[6]
  • About 2% of dermatology patients suffer from excoriation disorder.[3]


  • The age of onset for excoriation disorder is likely either under 10 years old or between 30 and 45 years old.[3]

Risk Factors

Common risk factors in the development of excoriation disorder include:

Natural History, complications, and prognosis

Natural History

  • The symptoms of excoriation disorder usually develop either under 10 years of age or between 30 and 45 years old.[3]


  • There are no known complications associated with excoriation disorder.


  • Those who suffer from this disorder tend to wear long sleeved clothing, even in warm weather, to hide any damaged skin. They are hindered by embarrassment when going out in public. If excoriation disorder is left untreated, it can last as long as 21 years.

Diagnostic Criteria

DSM-V Diagnostic Criteria for Excoriation (Skin-Picking) Disorder [6]

  • A. Recurrent skin picking resulting in skin lesions.


  • B. Repeated attempts to decrease or stop skin picking.


  • C. The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.


  • D. The skin picking is not attributable to the physiological effects of a substance (e.g.,cocaine) or another medical condition (e.g., scabies).


History and Symptoms

  • History of picking at the the skin
  • History of personal issues such as abuse that may lead to these behaviors.
  • Acne already preexisting on the body.

Laboratory Findings

  • There are no diagnostic laboratory findings associated with excoriation disorder.

Other Imaging Studies

  • There are no other imaging findings associated with excoriation disorder.

Other Diagnostic Studies

There are no other diagnostic studies associated with excoriation disorder.

Medical Therapy


  • These strategies help reduce skin picking behavior in individuals with excoriation disorder, but no psychological issues.[3][7][8]

Brain Stimulation Therapy

  • There is no brain stimulation therapy associated with excoriation disorder.

Cost Effectiveness of Therapy

Future or Investigational Therapies


  1. Deckersbach T, Wilhelm S, Keuthen NJ, Baer L, Jenike MA (2002). "Cognitive-behavior therapy for self-injurious skin picking. A case series". Behav Modif. 26 (3): 361–77. doi:10.1177/0145445502026003004. PMID 12080906.
  2. Black, Donald (2014). DSM-5 guidebook : the essential companion to the Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Publishing. ISBN 978-1585624652.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Odlaug BL, Grant JE (2010). "Pathologic skin picking". Am J Drug Alcohol Abuse. 36 (5): 296–303. doi:10.3109/00952991003747543. PMID 20575652.
  4. http://www3.interscience.wiley.com/cgi-bin/abstract/90513484/ABSTRACT?CRETRY=1&SRETRY=0
  5. Brain Explorer - Focus on Brain Disorders - OCD - Related Spectrum Disorders
  6. 6.0 6.1 6.2 6.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  7. Dell'Osso B, Altamura AC, Allen A, Marazziti D, Hollander E (2006). "Epidemiologic and clinical updates on impulse control disorders: a critical review". Eur Arch Psychiatry Clin Neurosci. 256 (8): 464–75. doi:10.1007/s00406-006-0668-0. PMC 1705499. PMID 16960655.
  8. Lang R, Didden R, Machalicek W, Rispoli M, Sigafoos J, Lancioni G; et al. (2010). "Behavioral treatment of chronic skin-picking in individuals with developmental disabilities: a systematic review". Res Dev Disabil. 31 (2): 304–15. doi:10.1016/j.ridd.2009.10.017. PMID 19963341.

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