What is excoriation?
It is not uncommon for people to pick at scabs or bumps on their skins from time to time but for some people, this picking can become very chronic. Picking the skin frequently can irritate existing sores and can even cause new sores to form which can lead to additional scabbing and scarring of the skin.
People with an excoriation disorder pick at their skin uncontrollably out of impulse which is something they struggle to control. This compulsion can be so uncontrollable that some people spend several times a day picking at their skin continuously.
This disorder is not a common one but it is very documented as it is considered a mental disorder that is related to obsessive-compulsive disorder (OCD). This does not mean everyone with OCD develops excoriation.
TYPES OF SKIN PICKING
- Automatic picking: This kind of picking happens on impulse without the person thinking about it. It involves running their hands or fingers across their skin in a scanning manner to find a spot that feels different. The different spot is then focused on for picking.
2. Focused picking: Just as the name implies, this kind is focused on specific areas of this skin, and picking of that area can go on for hours. This type can be very severe as they can pick too deep, bleed so much, get an infection or even have to get surgical treatment.
SIGNS AND SYMPTOMS OF EXCORIATION
- Picking at scabs, bumps, or other skin lesions till they start bleeding again or till they become inflamed.
- Picking at the skin around the fingernails and toenails.
- Allowing bleeding areas to heal just to start picking at them again until it becomes a cycle that can be difficult to change.
- Attempting to remove non-existent “imperfections” that do not exist by repeatedly scratching the skin in an attempt to remove the unrealistic imperfections they think they see on their skin.
- Spending large amounts of time picking at their skin to the point of being disrupted from their social and professional lives.
- Developing infections, lesions, or scars from frequently picking the skin.
- They avoid public places or events that might require less clothing because they do not want their skin appears to be seen by people due to the scars or infections.
CAUSES OF EXCORIATION
This disorder is described as a repetitive “self-grooming” behavior that is referred to as body-focused repetitive behavior (BFRB). Other types of body-focused repetitive behavior are hair picking and nail picking.
Excoriation is also classified as a type of Obsessive Compulsive Disorder (OCD) because it is the compulsive urge which is too powerful to be controlled that results in the constant picking of the skin and gives them little to no control over this behavior.
The causes of this disorder are still quite unclear but it is clear that this disorder often starts after it had been triggered once or twice by an event or stimulus, for example:
- Picking at the scab of an injury that has already started healing till it becomes a cycle.
- Uncontrollably itching of a healing injury resulting in the reopening can trigger picking.
- Using skin picking as a relief strategy when experiencing stress
Excoriation can occur in any age range and can also begin at any age but it usually becomes diagnosed in adolescence or once puberty begins. Statistics have shown that it is more likely to develop in women than in men.
The skin-picking disorder frequently coexists with a number of other disorders. These conditions may manifest as these illnesses or disorders, or they may have a number of similar underlying risk factors in common.
Other co-occurring illnesses share underlying risk factors with excoriation or could be symptoms of a condition. These conditions are:
- Obsessive-compulsive disorder (OCD): This disorder causes repetitive behaviors that interfere with a person’s quality of life and disrupt them from carrying out normal activities.
- Body dysmorphic disorder: Body dysmorphia is a condition that describes hating one’s body. People with this body-image disorder usually have negative thoughts about their body and this can lead to skin picking.
- Depression: Depression can also lead to skin picking.
- Other BFRBs: Other body-focused repetitive behaviors like nail biting, biting the lips until they bleed, and chewing on the inside of your cheeks can also result in skin picking.
TREATMENTS FOR EXCORIATION
Just like for other mental health conditions, it is advisable to see a mental health professional or counselor who can help with identifying the triggers that result in skin picking and also come up with coping mechanisms on how to stop picking the skin when triggered. Examples of coping mechanisms that can be used include squeezing a stress ball or playing with a Rubik’s cube. Activities involve the use of your hands and keeping them busy. A therapist can also help learn how to resist the things that trigger you in your environment or on your body. Also, properly wearing adhesive bandages over scabs or healing cuts can also help you avoid picking.
The most popular medication prescribed for excoriation is an SSRI (Selective Serotonin Reuptake Inhibitor). The disorder may also be lessened by antidepressants. Psychiatric and anticonvulsant drugs, which are used “off-label” because they are typically prescribed for other conditions but can help treat excoriation, are other medications that are used in the treatment of this disorder.
Because some people get triggered by the tingling or burning sensations of their skin, doctors may recommend the application of topical medications to reduce these sensations. Examples of topical medications are Antihistamine creams or topical steroids. They help reduce itching sensations. Some topical anesthetic creams (like lidocaine) or astringents can also help to reduce these sensations.
Even though the treatment of excoriation can help with managing the symptoms and the impulse of the behavior, it is possible to still experience it(relapse) again long after recovery. This does not mean this disorder cannot be completely overcome, it only means that the suitable treatment plan for you can change over time and your doctor must revisit the plan from time to time. The process of finding a treatment plan is also a matter of trial and error to see what works for you.