What Do We Know About Skin Picking Now? A Recent Review Reveals New Insights

In recent years, there’s been a lot of research on various aspects of skin picking disorder, clinically known as excoriation disorder or dermatillomania. Different models, varying interventions, and more. It’s a lot to take in and can leave you wondering, “What is the current thinking about skin picking disorder?”

A team of researchers asked that very question and in a March 2025 study, they reviewed the literature regarding the risk factors and comorbidities associated with skin picking, existing treatments, and what could be the future of treatment interventions for this disorder. 

Here’s what they found.

Risk Factors and Comorbidities

While the exact cause of skin picking is unknown, studies point to neurobiological underpinnings. Studies have shown that both brain function and structure may play a role in skin picking.

Skin picking seldom occurs in isolation. Comorbid conditions can impact the experience of skin picking. The review identified a number of comorbidities that are common in people with skin picking disorder:

Attention Deficit Hyperactivity Disorder (ADHD)

The review found a significant comorbidity between ADHD and skin picking. One large study of over 10,000 people with skin picking found that about 23.5% also had a diagnosis of ADHD. 

Post Traumatic Stress Disorder (PTSD)

A number of studies have demonstrated an association between PTSD and skin picking. In one study, as many as 72% of participants with PTSD showed symptoms of skin picking disorder. The reviewers suggest that these findings emphasize the need for screening for underlying trauma as part of the treatment process. 

Major Depressive Disorder (MDD)

A common comorbidity, studies suggest that about half of people with skin picking may also experience depression. And family history seems to play a role with about 23% reporting a family history of depression. 

Anxiety Disorders

Anxiety disorders, and in particular Generalized Anxiety Disorder (GAD), are also associated with skin picking. GAD is marked by excessive and persistent anxiety related to various aspects of daily life. A large study of over 10,000 adults found that 63.4% of those with skin picking disorder also had GAD. 

Not surprisingly, other comorbidities included trichotillomania (also a Body Focused Repetitive Behavior) and Obsessive Compulsive Disorder.

The high prevalence of comorbidities underscores the need for a comprehensive assessment when considering diagnosis and treatment. 

Treatment Approaches

The review yielded insight into what the researchers found to be the most efficacious evidence-based psychological and pharmacologic treatments:

Cognitive Behavioral Therapy (CBT) 

CBT addresses underlying thoughts and beliefs that drive behavior. The studies in the review demonstrated that CBT was effective in treating skin picking with participants reporting significant improvement. 

Habit Reversal Training (HRT)

HRT is considered by many to be the gold standard for treating BFRBs like skin picking. HRT targets skin picking behaviors through the development of competing responses. Studies have consistently shown that people using HRT experience significant reduction in skin picking behaviors. 

Because skin picking can involve both behavioral and cognitive components, HRT is often combined with other treatment approaches such as CBT or Acceptance and Commitment Therapy (ACT). 

Acceptance and Commitment Therapy (ACT)

ACT focuses on the acceptance of negative thoughts and feelings as part of the human experience and learning to respond to these negative thoughts and feelings in ways that align with a person’s values and goals. The review found that ACT may be helpful in reducing skin picking when combined with HRT.

Pharmacologic Interventions

Currently, there are no medications specifically approved by the FDA for treating skin picking. While Selective Serotonin Reuptake Inhibitors (SSRIs) are sometimes used as part of treatment to manage symptoms of comorbid conditions, the review found that their effectiveness for treating skin picking is mixed. 

So, what does seem to be promising according to the review?

N-acetylcysteine (NAC)

NAC is an amino acid that has received a lot of attention due to its role in glutamate modulation. Studies have found that NAC was associated with a significant improvement in skin-picking severity when compared to placebo. While much more research is needed, the results appear promising.

Memantine

Memantine is a relatively new medication that is used primarily to treat Alzheimer’s Dementia. More recently, it has gained attention as a possible pharmacologic intervention for treating BFRBs like skin picking. The review of studies found that people treated with memantine showed significant improvement in the severity of symptoms. Again, while not approved specifically approved to treat skin picking and research continues, the results are promising. 

It should be noted that your treatment needs are unique and working with a trained mental health provider is essential to positive treatment outcomes. Just because something sounds good doesn’t mean it’s right for you. You and your provider can work to determine the best treatments for you. 

Promising Technologies

Not surprisingly, tech is being looked at as a way to help treat skin picking. Wearable devices, like the ‘‘Tingle’’ device, use sensors to detect picking behavior and provide tactile feedback to help disrupt the picking. The review found that there is early evidence that this type of wearable devices may provide significant benefits for people with skin picking disorder who are also receiving HRT vs HRT alone. 

What the Future Holds 

Reviews like this one aid in understanding complex conditions like skin picking and highlight the need for education, early screening for risk factors, and integrated approaches. Ongoing research will continue to define and refine understanding and treatments for skin picking. 

In the meantime, there are effective approaches to treatment and help is available. If you’re struggling with your skin picking and wondering what treatment can do for you, SkinPick is here to help. Our team of experienced therapists can help you find the treatment options that work best for you. With online therapy, you can see your therapist when and how it works best for you. When you’re ready, your SkinPick therapist is here to help you find your path to recovery. 

References

1. Ortiz-López, L. I., Sakunchotpanit, G., Chen, R., Braun, N., Kim, E. J., Aihie, O. P., … Nambudiri, V. E. (2025). Skin-picking disorder: Risk factors, comorbidities, and treatments. JAAD Reviews, 3, 182-189. https://www.sciencedirect.com/science/article/pii/S2950198925000182#bib8

2. Memantine May Reduce Hair-Pulling, Skin Picking. (n.d.). Retrieved from https://psychiatryonline.org/doi/full/10.1176/appi.pn.2023.05.5.29