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Dermatillomania AKA Skin Picking: What Is It & How Do You Stop It?

Photographed by Ana Larruy.
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The first time I realised that picking my skin was less of a bad habit and more of a problem, I was tearing through King's Cross station on my way home from work, only to be stopped in my tracks by a concerned stranger.
"Are you ok? It's just your mouth," she pointed. "It's bleeding."
I’m one of the hordes of people who have been diagnosed with dermatillomania, otherwise known as skin picking disorder, and without even having realised I'd done it, I’d managed to pick an entire layer of skin away from my bottom lip while counting down the stations. Catching a glimpse of myself in the mirror, it looked like I'd face-planted the pavement.
For me, it's a regular occurrence. Almost every minute of the day, I pick my lips until it’s too painful to smile, gnaw at the skin around my nails until it’s too difficult to send a text and prod and scratch at ingrown hairs, spots or rough skin on my arms and legs until I’m left with pigmented and sometimes deep scars. But the thing is, I just can’t stop — and if the numbers are anything to go by, I’m not alone. In fact, consultant dermatologist, Dr. Justine Kluk, reports that figures suggest between 1.4% and 5.4% of people are affected by dermatillomania to varying degrees.
What is dermatillomania?
"In short, dermatillomania refers to picking of the skin," says Dr. Kluk. "Most of us will pick or scratch our skin from time to time, particularly if we have spots or an underlying skin disorder like eczema that makes us feel itchy. But what is different about dermatillomania is the degree to which the picking happens and the unpleasant feeling of not being able to stop."
"People with dermatillomania often pick subconsciously and it may happen more often when they are tired or bored, for example while watching TV," adds Dr. Kluk. "The areas most likely to be affected are those within easy reach of our hands, most commonly the face, hands, arms and legs," but a lot of people are known to pick even their ears and scalp, often causing infection and scarring.
"Picking is also more likely to occur at sites where the skin is raised or rough," says Dr. Kluk. "This includes pimples, dry, chapped lips or rough cuticles. People will sometimes use their teeth to bite their cuticles instead of picking with their fingers."
Who tends to suffer with dermatillomania?
According to Dr. Kluk, symptoms of dermatillomania can occur at any age, but generally start in adolescence, typically coinciding with the onset of puberty. Rather interestingly, it seems the majority of dermatillomania sufferers are women, and stress and anxiety are two of the main causes.
With that in mind, though, Dr. Kluk says it has been suggested that less than a fifth of dermatillomania sufferers actually get the help they need, due to embarrassment or believing that it will be untreatable — and that's something I can vouch for. In my mind, absentmindedly picking at my skin was such a trivial issue compared to other things people see their GP about — but we often don't realise just how debilitating the condition can be. I swerved a big family wedding because I'd picked a spot so raw it wouldn't stop weeping, and once on a date, my lip actually split mid-smile after I'd picked it all day out of nerves. I haven't been on one since.
"Dermatillomania can cause significant emotional distress and functional impairment, which shouldn’t be underestimated," says Dr. Kluk. "Some people spend hours trying to camouflage the marks that the picking has caused, meaning they may be late for work or shy away from intimate relationships. It is advisable to get professional help in these cases, and treatment is usually aimed at habit reversal and reducing stress and anxiety. It may also be helpful to see a dermatologist if the diagnosis is unclear, and because dermatillomania carries a risk of scarring, a dermatology opinion may be sought for advice about how to improve the appearance once the picking has stopped."
How I'm learning to manage my dermatillomania
Amping up my skincare routine
As Dr. Kluk has already mentioned, we're more likely to pick at skin that is rough or flaky, exacerbating the condition further. Most of us are sticklers when it comes to looking after our complexions (retinoids, acids — the list goes on), but as for our lips and hands? It's a totally different story. If your GP has suggested sticky balms or emulsions as deterrents but you can't stand the feel, try these:
Abnomaly's Petrowhat? in Baobab, £$9, contains amino acids to heal and moisturise lips and cuticles without the uncomfortable gloopy feeling, while CeraVe's Moisturising Lotion, $17.39, harnesses cell-building ceramides to repair skin, banish flaky bits and smooth away rough patches sans stickiness.
Regular physical or chemical exfoliation — using a body brush like the Aromatherapy Associates Revive Body Brush, $35, or enlisting body products that harness glycolic acid, such as Ameliorate's Transforming Body Lotion, $42 — will also help to keep roughness to a minimum, so you're less likely to pick.
Trying reflexology
I've tried everything from crystal sound baths to red wine therapy to combat my stress and anxiety levels, but nothing has been half as effective at chilling me out as reflexology.
I chose Living Mind on Harley Street, where trained practitioner, Malini Sarkhel, pressed on certain reflex points on my feet to balance and relax different parts of my body, including my mind — and boy does it work. I find it difficult to sleep anywhere that isn't my own bed, but I was out like a light, more or less floated out of my first session and noticed a significant decrease in anxious picking, which lasted for a good few days afterwards.
Rewarding myself
If I can go a few days without picking at my lips, I reward myself with a new lipstick, and if I leave my cuticles where they're supposed to be, a manicure. It's simple, but it works a treat.
Cognitive Behavioural Therapy
While I haven't yet tried this one, both Dr. Kluk and David Brudö, CEO and cofounder at personal development and mental wellbeing app, Remente, suggests Cognitive Behavioural Therapy (CBT) is a good option to stop the compulsion in its tracks. It consists of regular meetings with a trained therapist where thoughts, physical feelings and actions are analysed and broken down in a bid to quell said behaviour.
"Skin picking disorder is often misunderstood," Brudo says. "It's a symptom that can lead to a compulsion, and CBT could help get rid of the habit, especially if the skin picking is related to anxiety or depression."
If you think you might be in need of CBT, talk to your GP and ask to be referred.
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