Dermatillomania, also called excoriation disorder or skin-picking disorder, is a body-focused repetitive behavior classified in the DSM-5 under obsessive-compulsive and related disorders. The core feature is recurrent, compulsive picking of the skin that results in tissue damage. People with this condition may pick at healthy skin, minor irregularities such as pimples or calluses, scabs from previous picking episodes, or areas that feel rough or uneven.

Common signs and symptoms include:

• Repetitive picking at one or more body sites, most commonly the face, arms, hands, and upper body, though any area can be targeted.
• Visible skin damage such as open sores, scarring, discoloration, or chronic wounds that are slow to heal.
• Preceding tension or urge before picking, followed by a feeling of relief, gratification, or reduced anxiety afterward.
• Automatic (unfocused) picking that occurs outside of conscious awareness, for example while reading, watching television, or driving.
• Focused picking performed deliberately, sometimes in front of a mirror, often triggered by the sight or feel of a skin irregularity.
• Use of tools such as tweezers, pins, or fingernails to dig at or extract material from the skin.
• Repeated unsuccessful attempts to stop or reduce the behavior.
• Emotional consequences including shame, guilt, embarrassment, and frustration after picking episodes.

The severity of dermatillomania varies. Some individuals pick for a few minutes at a time, while others engage in prolonged sessions lasting an hour or more. The behavior often fluctuates with stress levels, emotional states, and hormonal changes. Many people develop elaborate rituals around picking and concealment, spending significant time covering wounds with makeup, bandages, or clothing.

A diagnosis of excoriation (skin-picking) disorder is made when a person engages in recurrent skin picking that results in skin lesions, has made repeated attempts to decrease or stop the behavior, and experiences clinically significant distress or impairment in social, occupational, or other important areas of functioning. The picking must not be attributable to the effects of a substance or another medical condition, and it must not be better explained by symptoms of another mental disorder.

Dermatillomania frequently co-occurs with other conditions, including obsessive-compulsive disorder, trichotillomania (hair-pulling disorder), major depressive disorder, anxiety disorders, and body dysmorphic disorder. A thorough clinical evaluation helps identify these overlapping conditions so treatment can address the full picture.

Cognitive-behavioral therapy (CBT) is considered the first-line treatment for dermatillomania. A specific form of CBT called habit reversal training (HRT) teaches individuals to identify the situations, emotions, and sensory experiences that trigger picking, and to replace the picking behavior with a competing response that is less harmful. Stimulus control strategies, such as keeping hands busy, covering mirrors, or wearing gloves, are often incorporated.

Acceptance and commitment therapy (ACT) and comprehensive behavioral treatment (ComB) are also used. These approaches help people develop greater tolerance for the urges to pick without acting on them, while building a life guided by personal values rather than controlled by the disorder.

Many people with dermatillomania have never discussed their picking with anyone, including their doctor. This silence is usually driven by shame. It is worth knowing that dermatillomania is far more common than most people realize and that clinicians who specialize in body-focused repetitive behaviors treat it routinely.

You should consider seeking professional help if your skin picking is causing noticeable tissue damage or scarring, if you have tried to stop on your own but cannot, or if the behavior is causing you significant emotional distress. It is also important to get help if skin picking is leading you to avoid social situations, miss work or school, or withdraw from relationships.

If your skin picking has caused wounds that appear infected (increasing redness, warmth, swelling, or pus), seek medical attention promptly. Chronic picking can occasionally lead to serious complications including cellulitis and septicemia.

Start by talking with your primary care provider or a mental health professional. Look specifically for therapists who list body-focused repetitive behaviors, excoriation disorder, or obsessive-compulsive spectrum disorders among their specialties. The TLC Foundation for Body-Focused Repetitive Behaviors maintains a therapist directory and educational resources.

For more information, consult these trusted sources:

• National Institute of Mental Health: Obsessive-Compulsive and Related Disorders
• American Psychiatric Association: What Is OCD?
• NHS: Skin Picking Disorder

Remember that this online screening test is not a diagnosis. Only a qualified healthcare provider can diagnose excoriation disorder. If your results concern you, use them as a starting point for a conversation with a professional.