Skin picking or excessive scratching may seem like a harmless habit to some, but for many people, it’s far more serious than that. Whether it’s a subconscious response to stress or a compulsive behaviour tied to a deeper mental health issue, skin picking can cause significant damage not just to your skin, but also to your emotional well-being and self-confidence.
This behaviour is often linked to a condition known as dermatillomania, or skin-picking disorder, which falls under the umbrella of body-focused repetitive behaviours (BFRBs). People with dermatillomania may pick at healthy skin, blemishes, scabs, or perceived imperfections to the point of bleeding, infection, or scarring. And while some may feel temporary relief, the cycle often results in guilt, shame, and worsening skin damage over time.
You might be wondering: is this something a dermatologist can actually help with? The answer is yes and often, they are one of the first professionals people turn to when the physical effects of skin picking start to take a toll. While dermatologists are not mental health specialists, they are uniquely positioned to assess the skin damage caused by repeated picking or scratching, rule out underlying dermatological conditions that may be triggering the behaviour (like eczema or acne), and provide treatment plans to reduce inflammation, support skin healing, and break the cycle.
In this article, we’ll take a closer look at how dermatologists can play a key role in managing skin-picking and scratching habits. We’ll also explore how they collaborate with psychologists or psychiatrists when a behavioural health component is involved, and what treatment options are available to support both your skin and your mental well-being.
What Is Skin Picking or Scratching?
Skin picking or scratching refers to the repetitive, and often unconscious or uncontrollable, urge to touch, pick at, or scratch the skin. While occasional picking such as removing a scab or scratching an itch is common, for some people, this behaviour becomes compulsive and difficult to stop. Over time, it can lead to significant skin damage, bleeding, infections, scarring, and emotional distress.
This behaviour exists on a spectrum. In some cases, it’s a mild habit that flares up during times of stress. In others, it develops into a serious condition that interferes with daily functioning. Experts typically recognise two main categories of skin-picking and scratching behaviours:
1. Dermatillomania (Skin-Picking Disorder)
Dermatillomania, also known as Excoriation Disorder, is a mental health condition classified under body-focused repetitive behaviours (BFRBs). It involves recurrent and compulsive picking at the skin, usually in response to anxiety, stress, or a strong internal urge. People with dermatillomania may pick at perceived imperfections, such as blemishes, scabs, or dry patches even when the skin is otherwise healthy.
This condition often leads to:
- Visible skin damage, including open wounds, sores, and long-lasting scars
- Infections due to repeated breaking of the skin barrier
- Emotional distress, such as guilt, shame, or embarrassment
- Avoidance behaviours, such as hiding parts of the body or withdrawing from social activities
While dermatillomania shares similarities with obsessive-compulsive disorder (OCD), it is recognised as a distinct condition and typically requires a combined treatment approach that addresses both the physical skin damage and the psychological drivers behind the behaviour.
2. Habitual Skin Scratching or Picking
Not all skin-picking behaviours meet the criteria for a clinical disorder like dermatillomania. In many cases, people develop habitual scratching or picking routines in response to everyday stressors, boredom, nervous energy, or even as a form of self-soothing.
These behaviours may include:
- Absent-minded picking or scratching while watching TV, reading, or working
- Targeting specific areas, such as the face, scalp, arms, or legs
- Responding to minor skin issues, like dryness, bug bites, or acne, in an excessive way
- Increasing frequency during periods of emotional tension
While these habits may start off as harmless, they can quickly escalate. Over time, repeated trauma to the skin can cause chronic inflammation, thickening of the skin (lichenification), pigmentation changes, and psychological impacts similar to those seen in dermatillomania especially if the person feels unable to stop.
In some cases, habitual picking is triggered by underlying dermatological conditions such as eczema, acne, seborrheic dermatitis, or psoriasis, which cause discomfort or irritation and prompt scratching. In others, it’s purely behavioural and requires a multi-disciplinary approach for effective treatment.
How Can Dermatologists Help with Skin-Picking and Scratching Habits?
If you’re struggling with skin-picking or scratching whether it’s a subconscious habit or a more serious, compulsive behaviour you might be wondering if a dermatologist in London can offer any real help. The answer is yes. While dermatologists may not directly treat the psychological aspects of skin-picking disorders, they play a crucial role in identifying the physical triggers, diagnosing underlying conditions, and helping you manage the visible damage to your skin.
Here’s how dermatologists can support individuals dealing with skin-picking or scratching:
1. Ruling Out Underlying Skin Conditions
In many cases, the urge to pick or scratch at the skin isn’t random it’s often driven by discomfort or irritation caused by an underlying skin condition. Common culprits include:
- Acne: The presence of pimples, blackheads, or clogged pores can trigger picking, especially when individuals attempt to “fix” or extract blemishes.
- Eczema (Atopic Dermatitis): Chronic itching associated with eczema can lead to repeated scratching, which breaks the skin and may evolve into a skin-picking habit.
- Psoriasis: The thick, scaly plaques of psoriasis can cause discomfort, and scratching or picking at them can worsen inflammation.
- Fungal Infections: Conditions like ringworm or athlete’s foot cause intense itching and irritation, which can lead to scratching that becomes habitual.
- Contact Dermatitis: Allergic or irritant reactions can result in red, itchy rashes that provoke scratching and picking.
What Dermatologists Do:
A dermatologist will begin with a comprehensive skin examination, taking note of the types of lesions, their distribution, and your medical history. If necessary, they may perform skin scrapings, patch testing, or biopsies to confirm or rule out specific conditions.
Once the underlying issue is identified, they will design a treatment plan that targets the root cause, which can significantly reduce the urge to scratch or pick.
Example:
If acne is found to be the main trigger, a dermatologist may prescribe topical retinoids, benzoyl peroxide, antibiotics, or oral medications like isotretinoin to reduce inflammation and prevent new breakouts. As the skin clears, the compulsion to pick at blemishes often lessens.
Similarly, in cases of eczema, they might recommend a moisturising routine combined with prescription-strength topical corticosteroids or calcineurin inhibitors to reduce itching and inflammation, making it easier to break the scratching cycle.
2. Offer Treatment for Skin Damage
Beyond addressing the root causes of skin-picking behaviours, dermatologists also play a vital role in treating the physical aftermath. For many people who struggle with chronic picking or scratching, the most distressing part is the visible damage it leaves behind such as open sores, dark marks, scabs, thickened skin, and permanent scarring. This damage can take a significant toll on self-esteem and body image, especially when it appears on prominent areas like the face, arms, or legs.
Fortunately, dermatologists have access to a wide range of treatments designed to promote healing, reduce inflammation, and improve the appearance of damaged skin. These treatments not only help with the physical recovery but can also encourage behavioural progress people are often more motivated to stop picking when they begin to see their skin healing.
Treatment Options May Include:
- Topical Healing Treatments: Dermatologists may prescribe or recommend topical products that support skin regeneration and barrier repair. These can include medicated ointments containing zinc, vitamin E, hyaluronic acid, or growth factors that encourage the skin to heal more quickly and with less risk of scarring.
- Prescription Creams for Inflammation: In cases where inflammation persists, topical corticosteroids or non-steroidal anti-inflammatory creams may be prescribed to soothe irritated skin, reduce redness, and relieve itching thereby breaking the scratch–itch cycle.
- Scar Reduction Therapies: For those dealing with long-term scarring, dermatologists can offer targeted treatments to minimise the appearance of marks left by repeated picking. These may include:
- Silicone gel sheets or silicone-based creams, which are clinically proven to flatten and fade hypertrophic or keloid scars.
- Chemical peels or microdermabrasion, which help to improve skin texture and reduce hyperpigmentation over time.
- Laser therapy (such as fractional laser or pulsed dye laser), which can be used to treat deeper or more stubborn scars by stimulating collagen production and encouraging skin renewal.
- Treatment for Pigmentation Changes: Post-inflammatory hyperpigmentation (dark spots) or hypopigmentation (light spots) caused by skin trauma can also be treated using lightening creams (e.g., azelaic acid, retinoids, hydroquinone) or more advanced interventions depending on the severity.
Why It Matters:
By directly treating the damage caused by picking or scratching, dermatologists can restore the skin’s appearance and help rebuild your confidence. In many cases, visible improvement in the skin’s condition also helps reduce the emotional triggers for picking creating a positive feedback loop that supports recovery.
This stage of treatment is particularly important for people who feel trapped in a cycle: they pick because they’re anxious about their skin, and then feel even more anxious when the damage worsens. Breaking that cycle with targeted dermatological care can make a significant difference in both physical healing and emotional well-being.
3. Collaborate with Other Healthcare Providers
While dermatologists can treat the visible effects of skin-picking, the behaviour itself is often rooted in deeper psychological patterns. In cases of dermatillomania (skin-picking disorder) or chronic, habitual scratching, a more holistic and integrated treatment plan is often necessary to address both the physical and emotional aspects of the condition.
Dermatologists are well-positioned to act as the first point of contact and can play a crucial role in initiating referrals and coordinating care with other healthcare professionals. Many people with skin-picking habits benefit from a multidisciplinary approach, which combines dermatological treatment with mental health support and medical management.
Here’s how dermatologists contribute to a collaborative care model:
- Referral to Mental Health Professionals: When skin-picking is driven by anxiety, obsessive-compulsive tendencies, or emotional distress, dermatologists may refer patients to a psychologist, psychiatrist, or behavioural therapist. One of the most effective therapies for skin-picking is Cognitive Behavioural Therapy (CBT), especially when it includes Habit Reversal Training (HRT). These approaches help individuals identify the triggers behind their behaviours, develop coping strategies, and learn healthier responses to stress.
- Working with GPs and Primary Care Providers: In many cases, a general practitioner (GP) is also involved in overseeing a patient’s overall mental and physical health. Dermatologists often liaise with GPs to ensure that treatment plans are coordinated, and any medications prescribed do not conflict with existing health conditions or treatments.
- Prescribing Medications When Needed: For some patients, dermatologists may prescribe medications either alone or in consultation with a GP or psychiatrist that can help reduce the urge to pick. These might include:
- Selective Serotonin Reuptake Inhibitors (SSRIs), a class of antidepressants that have shown effectiveness in managing compulsive behaviours.
- Anxiolytics or mood stabilisers, depending on the severity of symptoms and any coexisting conditions such as generalised anxiety disorder or depression.
- Behavioural Support and Education: Dermatologists can also educate patients about behavioural triggers, suggest tools like fidget devices, skin-safe distraction techniques, or recommend mobile apps designed for people with BFRBs (Body-Focused Repetitive Behaviours). This reinforces the work done in therapy and helps patients stay consistent with their behavioural changes.
Why Collaboration Matters:
Skin-picking is rarely just a “bad habit.” For many, it’s a deeply entrenched behaviour linked to emotional distress, neurobiological factors, or even trauma. Without addressing the psychological component, skin-picking can become a long-term issue, even if the skin itself is treated effectively.
By working together, dermatologists, GPs, and mental health providers can offer patients a well-rounded care plan that treats not just the skin, but the underlying causes of the behaviour. This collaborative approach increases the chances of long-term recovery and reduces the likelihood of relapse.
4. Provide Guidance on Preventing Recurrence
Successfully managing skin-picking or scratching habits isn’t just about treating the visible damage it also involves learning how to break the cycle and prevent the behaviour from returning. This is where dermatologists play a key role in providing long-term preventative strategies tailored to your specific needs and triggers.
Even after the skin has healed, the urge to pick can remain, especially if it’s linked to stress, anxiety, or ingrained behavioural patterns. Without proper guidance, many individuals find themselves stuck in a frustrating cycle of picking, healing, and recurrence. Dermatologists can help interrupt this cycle by offering practical, evidence-based solutions that go beyond surface-level treatments.
Here are some of the ways dermatologists can help you prevent recurrence:
- Developing a Personalised Skin Care Routine: Dermatologists will often recommend a gentle, consistent skin care routine that keeps your skin healthy and less prone to irritation. When your skin looks and feels better, you may feel less tempted to pick at imperfections like bumps, dryness, or scabs. This routine may include:
- Fragrance-free cleansers and moisturisers to minimise sensitivity
- Soothing serums or topical treatments that reduce inflammation and redness
- Non-comedogenic products to help prevent clogged pores and acne
- Identifying Triggers: Some people pick their skin when they feel stressed, anxious, bored, or overstimulated. Dermatologists can help you track when the urge to pick occurs and explore the emotional or environmental triggers behind it. This self-awareness is often the first step in creating healthier coping mechanisms.
- Teaching Behavioural Substitution Techniques: To reduce the impulse to pick, dermatologists may recommend behavioural interventions, such as:
- Keeping your hands busy with stress balls, fidget toys, or textured objects
- Practising mindfulness or grounding techniques to become more aware of your picking habits in the moment
- Scheduling short breaks during the day to focus on deep breathing or light stretching to reduce anxiety
- Using Physical Barriers: Covering the skin is another effective way to interrupt the picking cycle. Dermatologists often suggest barrier methods such as:
- Wearing cotton gloves at home, particularly during high-risk times like watching TV or scrolling on your phone
- Using bandages or hydrocolloid patches to cover wounds or blemishes
- Applying protective creams that make the skin less accessible or tactile
- Reinforcing Positive Changes: As you begin to see improvements in your skin and experience fewer urges to pick, dermatologists can help you maintain momentum by adjusting your treatment plan, monitoring your progress, and providing ongoing encouragement.
Why Preventative Guidance Matters:
Without proper strategies in place, skin-picking habits often return even after successful treatment. By equipping you with the tools to understand your triggers and take proactive steps, dermatologists help ensure that your progress isn’t temporary. Prevention is just as important as treatment, and it can empower you to feel more in control of your skin and your overall well-being.
When Should You See a Dermatologist About Skin-Picking?
If you’ve noticed that your skin-picking or scratching is:
- Persistent and does not improve with over-the-counter treatments
- Causing visible damage to your skin, such as scarring, infections, or lesions
- Interfering with your daily life or affecting your mental health
It may be time to consult a dermatologist in London for further evaluation and treatment. Dermatologists can help identify the cause of your skin-picking habits and provide tailored treatment plans to address both the physical and emotional aspects of the behaviour.
Final Thought: Support Is Closer Than You Think
If you’re struggling with skin-picking or scratching habits, know that you’re not alone. A dermatologist in London can play a key role in diagnosing underlying conditions, managing skin damage, and working alongside mental health professionals to address the behavioural aspects of the habit.
You can get in touch with us to book a consultation with one of our expert dermatologists in London. We offer compassionate and confidential care to help you manage your skin-picking habits and improve your overall skin health.
References:
- Lee, A.D. et al. (2025) Treatment strategies for skin picking disorder: Efficacy of pharmacological and non‑pharmacological approaches A systematic review and evidence mapping, Journal of the Academy of Consultation‑Liaison Psychiatry. https://www.sciencedirect.com/science/article/pii/S2950198924000667
- Loftus, H., Cassidy, C. & Mun, L. (2024) A Systematic Review of Non‑Pharmacological Treatment Options for Skin Picking Disorder (SPD), Clinical and Experimental Dermatology. https://pubmed.ncbi.nlm.nih.gov/39215568/
- Grant, J.E. & Odlaug, B.L. (2020) Psychodermatology of skin picking (excoriation disorder), Journal of Clinical Psychiatry Review Article. https://pubmed.ncbi.nlm.nih.gov/32447793/
- Snorrason, I., Keuthen, N.J. et al. (2022) Characteristics of 262 adults with skin picking disorder, Comprehensive Psychiatry. https://www.sciencedirect.com/science/article/pii/S0010440X2200044X
- July, F. & Bowes, L.E. (2022) Successful treatment of compulsive skin‑picking disorder with oral N‑acetylcysteine, British Journal of Dermatology, 187(S1), p. 227. https://academic.oup.com/bjd/article/187/S1/227/6700563