N-Acetylcysteine for skin picking: new research

Tasneem Abrahams
Jun 21st, 2016

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A recent study suggests that the use of n-acetylcysteine has had a remarkable effect in treating excoriation or  compulsive skin picking disorder. At the study’s end point, of the 53 participants who completed the study, 47% receiving N-acetylcysteine were much or very much improved compared 19% receiving a placebo The n-acetylcysteine showed no side effects and seemed to be well tolerated and effective.

What is excoriation disorder?

Previously known as dermatillomania, excoriation disorder refers to the compulsive and repetitive picking of one's own skin. People who suffer from excoriation disorder feel an uncontrollable urge to pick at their skin, followed by a sense of relief. Some will pick their skin automatically, without realizing they are doing it, while others feel a strong urge prior to picking and are aware that they are doing it.  Some sufferers will chew their skin or scabs afterwards. People with the disorder will often pick in private out of a sense of shame about performing the act. While severe skin picking can cause real damage and harm to the person's skin, this is not the intention. This is an important distinction to make from self-harm when diagnosing excoriation disorder.

While the cause of compulsive skin picking is still unclear, it is thought to be likely caused by an imbalance in certain brain chemicals and some undetermined environmental factors. Some researchers postulate that it is triggered by over-activity in the human brain of a neurotransmitter called glutamate, which has a wide variety of physiological functions.  Risk factors include family history, age (onset seems to be between the ages of 11 and 13) and negative emotions that is dealt with by the picking the skin. Complications from excoriation disorder include emotional distress, social and job problems, and skin and hair damage. 

Excoriation disorder is treated with psychotherapy, including habit modification. Some patients are taught to either sit on their hands or clench their fists when the urge to pick comes over them. Cognitive therapy is sometimes used to help the patient understand what some of the underlying causes of the compulsions are to better be able to deal with it. Acceptance therapy is used to help the person with the condition accept the compulsion without giving in to it.

Sometimes, a health care provider will prescribe medication to help alleviate the manifestation of excoriation disorder. Antidepressants are used to deal with whatever negative emotions might occur that trigger the hair pulling. More recently, n-acetylcysteine has been used to deal with the neurotransmitters in the brain that are thought to be a direct cause of the compulsive skin picking. Medications have side effects and should only be resorted to under the care of a doctor.

What is n-acetylcysteine?

According to WebMD, n-acetylcysteine is an over-the-counter supplement that is derived from the amino acid L-cysteine. It is used for a variety of medical purposes, such as counteracting Tylenol and carbon monoxide poisoning, chest pain caused by angina, Lou Gehrig’s disease, Alzheimer’s disease, and other illnesses. The use of n-acetylcysteine is also thought to mitigate against the risk of cancer, heart disease, and strokes. It is also used to combat certain lung diseases and liver damage due to alcoholism.

How does n-acetylcysteine treat excoriation disorder?

According to the NCBI, n-acetylcysteine is beginning to be explored as a treatment for a number of psychiatric ailments, including bi-polar disorder, certain drug  and other addictions,  and obsessive compulsive disorders such as trichotillomania. Researchers believe that the ingestion of n-acetylcysteine seems to regulate the production of dopamine and glutamate. The over-abundance of these neurotransmitters tends to lead to disorders such as excoriation disorder.

Incidentally, the use of n-acetylcysteine was seen to have some benefit for other grooming disorders, such as nail biting and hair pulling. 

The bottom line

The results of the studies referenced above strongly suggest that n-acetylcysteine could be an effective treatment for skin picking. Since the supplement is available over the counter, or even on Amazon  style= one might be tempted to buy some from the pharmacy or the health food store and try it out on one’s own. But any substance that affects brain chemistry should be approached with caution. Even ordinary supplements can cause unforeseen interactions with medications, other supplements, and even food.

Anyone seeking n-acetylcysteine to treat either their skin picking disorder or who is concerned about a loved one suffering from the syndrome should seek the advice of a doctor in its use. However, it appears that n-acetylcysteine holds a great deal of promise for mitigating a compulsion that not only causes social embarrassment, but can lead to physical health problems, as well.

Tasneem Abrahams

Tasneem is an Occupational Therapist, and a graduate of the TLC foundation for BFRBs professional training institute. Her experience in mental health includes working at Lentegeur Psychiatric hospital forensic unit (South Africa), Kingston Community Adult Learning Disability team (UK), Clinical Specialist for the Oasis Project Spelthorne Community Mental Health team (UK). Tasneem is a member of both the editorial team and the clinical staff on Skinpick, providing online therapy for people who suffer from excoriation (skin picking) disorder.

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