Abstract
Skin-picking disorder (SPD) is a common, repetitive, compulsive and distressing disorder with significant psychosocial effects. Data from relatively few clinical trials support behavioural therapies, especially habit-reversal therapy, as the first-line treatment. Depending on the individual’s SPD style and comorbidities, augmenting habit-reversal therapy with other behavioural therapies or pharmacological options, particularly glutamatergic modulators or specific serotonin-reuptake inhibitors, may enhance treatment outcomes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Jafferany M, Patel A. Skin-picking disorder: a guide to diagnosis and management. CNS Drugs. 2019;33(4):337–46.
Diagnostic and statistical manual of mental disorders (DSM-5). Washington DC: American Psychiatric Association; 2013.
Arnold LM, Auchenbach MB, Mcelroy SL. Psychogenic excoriation. CNS Drugs. 2001;15(5):351–9.
Gupta A, Jafferany M. Psychocutaneous disease. In: Sadock BJ, Sadock VA, Ruiz P, editors. Kaplan and Sadock’s comprehensive textbook of psychiatry. 10th ed. Philadelphia: Lippincott William & Wilkins; 2000.
Koo JYM, Lee CS. General approach to evaluating psychodermatological disorders. In: Koo JYM, Lee CS, editors. Psychocutaneous medicine. New York: Marcel Dekker, Inc.; 2003. p. 1–29.
Jones G, Keuthen N, Greenberg E. Assessment and treatment of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder. Clin Dermatol. 2018;36(6):728–36.
Gupta M. Body-focused repetitive behaviors (BFRB) (trichotillomania, skin picking, onychophagia) and eating disorders (ED): preliminary findings in a nondermatologic sample. J Am Acad Dermatol. 2016;74(5):46.
Ricketts EJ, Snorrason Í, Kircanski K, et al. A latent profile analysis of age of onset in pathological skin picking. Compr Psychiatry. 2018;87:46–52.
Keuthen NJ, Tung ES, Woods DW, et al. Replication study of the Milwaukee inventory for subtypes of trichotillomania-adult version in a clinically characterized sample. Behav Modif. 2015;39(4):580–99.
Snorrason I, Smári J, Olafsson RP. Emotion regulation in pathological skin picking: findings from a non-treatment seeking sample. J Behav Ther Exp Psychiatry. 2010;41(3):238–45.
Schuck K, Keijsers GP, Rinck M. The effects of brief cognitive-behaviour therapy for pathological skin-picking: a randomised comparison to wait-list control. Behav Res Ther. 2011;49(1):11–7.
Teng EJ, Woods DW, Twohig MP. Habit reversal as a treatment for chronic skin picking: a pilot investigation. Behav Modif. 2006;30(4):411–22.
Flessner CA, Busch AM, Heideman PW, et al. Acceptance enhanced behavior therapy (AEBT) for trichotillomania and chronic skin picking: exploring the effects of component sequencing. Behav Modif. 2008;32(5):579–94.
Schumer MC, Bartley CA, Bloch MH. Systematic review of pharmacological and behavioral treatments of skin picking disorder. J Clin Psychopharmacol. 2016;36(2):147–52.
Selles RR, McGuire JF, Small BJ, et al. A systematic review and meta-analysis of psychiatric treatments for excoriation (skin-picking) disorder. Gen Hosp Psychiatry. 2016;41:29–37.
McFarland K, Lapish CC, Kalivas PW. Prefrontal glutamate release into the core of the nucleus accumbens mediates cocaine-induced reinstatement of drug-seeking behaviour. J Neurosci. 2003;23(3):3531–7.
Grant JE, Odlaug BL, Kim SW. Lamotrigine treatment of pathologic skin picking: an open label study. J Clin Psychiatry. 2007;68(9):1384–91.
Arbabi M, Farnia V, Balighi K, et al. Efficiency of citalopram in treatment of pathological skin picking: a randomized double-blind placebo controlled trial. Acta Med Iran. 2008;46(5):367–72.
Grant JE, Odlaug BL, Chamberlain SR, et al. A double-blind placebo-controlled trial of lamotrigine for pathological skin picking: treatment efficacy and neurocognitive predictors of response. J Clin Psychopharmacol. 2010;30(4):396–403.
Jafferany M, Osuagwu FC. Use of topiramate in skin picking disorder:a pilot study. Prim Care Companion CNS Disord. 2017;19(1).
Sasso DA, Kalanithi PS, Trueblood KV, et al. Beneficial effects of the glutamate-modulating agent riluzole on disordered eating and pathological skin-picking behaviors. J Clin Psychopharmacol. 2006;26(6):685–7.
Grant JE, Chamberlain SR, Redden SA, et al. N-Acetylcysteine in the treatment of excoriation disorder: a randomized clinical trial. JAMA Psychiatry. 2016;73(5):490–6.
Keuthen NJ, Jameson M, Loh R, et al. Open label trial of escitalopram treatment for pathological skin picking. Int Clin Psychopharmacol. 2007;22(5):268–74.
Simeon D, Stein DJ, Gross S, et al. A double-blind trial of fluoxetine in pathologic skin picking. J Clin Psychiatry. 1997;58(8):341–7.
Bloch MR, Elliott M, Thompson H, et al. Fluoxetine in pathological skin picking: open label and double-blind results. Psychosomatics. 2001;42(4):314–9.
Arnold LM, Mutasim DF, Dwight MM, et al. An open clinical trial of fluvoxamine treatment of psychogenic excoriation. J Clin Psychopharmacol. 1999;19(1):15–8.
Sharma H. Psychogenic excoriation responding to fluoxetine: a case report. J Indian Med Assoc. 2008;106(4):245–62.
Author information
Authors and Affiliations
Consortia
Ethics declarations
Funding
The preparation of this review was not supported by any external funding.
Conflict of interest
The article was adapted from CNS Drugs; 2019:33(4):337–46 [1] by employees of Adis International Ltd./Springer Nature, who are responsible for the article content and declare no conflicts of interest.
Rights and permissions
About this article
Cite this article
Adis Medical Writers. Patchy evidence in skin-picking disorder supports management with combined behavioural and drug treatments. Drugs Ther Perspect 35, 607–611 (2019). https://doi.org/10.1007/s40267-019-00674-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40267-019-00674-0