Skin Picking In Children: Signs, Causes, And Treatment

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Skin picking in children is a repetitive behavior characterized by picking the skin. It is most common in teenagers and children under ten years old. While for most people, it is a rare instance, for others, it might become a habit that can turn into a skin-picking disorder. Frequent skin picking can cause skin lesionsⁱAn abnormal change or damage to the tissues caused by an injury or a disease (1) (2). However, children with the condition may feel out of control when it comes to stopping or decreasing their habits. In a multi-institute case-control study examining patients with excoriation disorder, it was found that they exhibited 28.48 times higher odds of Obsessive-Compulsive Disorder (OCD) (9). Read on to know the causes, symptoms, effects, and treatments for skin picking in children.

Signs Of Skin Picking Disorder

As per the criteria set by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the following signs and symptoms could confirm a diagnosis of skin picking disorder in children (3).

• Recurrent skin picking resulting in lesions
• Repeated attempts at changing the behavior
• Skin picking that causes significant stress, adversely affects one’s mental health or impairment to one’s daily life
• Skin picking that is not associated with the effects of a medication or medical condition such as scabies
• Symptoms are not linked to a psychiatric condition, stereotypic movement disorder, body dysmorphic disorder, or non-suicidal self-injurious tendencies

Children with skin picking or excoriation may not realize they are picking at their skin and may easily be triggered by situational factors. They do not necessarily restrict their picking to a single spot on the body, which leads to the classification of the behaviors as either focused excoriationⁱA behavior where the person tends to pick a specific spot in the body and tends to pick at the skin for prolonged periods of time or automatic excoriationⁱA behavior where the person tends to scan the body for uneven areas of skin, such as scabs or pimples, to pick at . Furthermore, their picking behavior may or may not be triggered by visible scabs, scars, acne, eczema, or pimples but is almost always indicated by the presence of unexplained wounds, scabs, scars, skin irritations, inflammations, or pain afterward (2) (8).

Quick fact

Children with skin picking disorder may pick on frecklesⁱSmall, flat, brown spots on the skin that may aggravate upon sun exposure , moles scars or spots to smoothen or “perfect” them (8).

Diagnosis Of Skin Picking In Children

If the general doctor suspects skin picking disorder in your child, they may refer them to a mental health professional, who will examine your child’s behavior and take a thorough history. A doctor may predominantly check to see if any of the child’s behaviors match the diagnostic criteria given in the DSM-5. Apart from this, they may check the child for visible deep or widespread wounds from picking, the tool used to pick, the frequency of the behavior, and the ability to cease the behavior. The doctor may also ask if the child’s behavior interferes with their mental health, social relationships, academic performance, day-to-day functioning, and perception of self. This evaluation can help make an accurate diagnosis, identify any psychiatric conditions, and rule out similar conditions (2) (4).

Causes Of Skin Picking In Children

The exact cause of skin picking in children is not known. However, research suggests that skin picking is more prevalent in individuals with OCD, and their immediate family may be genetically predisposed to this condition (1).

The condition is prevalent in those with at least one first-degree relative who has dermatillomania or excoriation disorder. They may be at risk if they have conditions like onychophagiaⁱAlso called nail biting disorder, this is a chronic, repetitive, and compulsive habit of biting one's nails , trichotillomaniaⁱAlso called hair pulling disorder, this condition is characterized by an irresistible urge to pull out one's own hair resulting in visible bald spots an distress , bipolar disorder, and Prader-Willi syndromeⁱA rare genetic disorder that affects many parts of the body, including the brain, metabolism, and endocrine system (10).

Major depression and anxiety disorders are the other most common psychiatric disorders that coexist with skin picking. Besides, anemiaⁱA condition where the body has low levels of healthy blood cells or hemoglobin , uremiaⁱA serious kidney disorder where waste and toxins from urine accumulate in the blood , or liver diseases may also cause behavioral disorders, such as skin picking.

In some cases, certain stressful events or situations may trigger skin-picking episodes in children. In contrast, a few children might indulge in skin picking as they associate it with feelings of relief or pleasure (5).

Dr. Jared Heathman, a board-certified psychiatrist from Cypress, Texas, says, “Anxiety can cause skin picking due to the link between stress and the development or worsening of the behavior. Therefore, when a person is anxious, they may be more likely to engage in repetitive behaviors such as skin picking to cope with their stress or anxiety. Additionally, skin picking can become a habit or compulsive behavior used to manage their anxiety, even if it ultimately worsens the anxiety in the long run.”

Manifestations Of Skin Picking Disorder

How and where people pick their skin may differ from person to person. The face (eyebrows, eyelashes, sidelocks, lips), head, nailbeds or cuticles, back, arms, legs, hands, and feet are the most common areas people pick their skin. A few uncommon places include the neck, gums, shoulders, thighs, pubic region, stomach, and chest. Some children might pick their skin with their nails and fingers, while others might use scissors and tweezers or resort to biting (6).

Effects Of Skin Picking Disorder

The effects of compulsive skin picking in children can range from mild to extreme. Some children might pick the skin from scabsⁱA hard protective layer of dried blood that forms over a wound on the skin or a rash, which can worsen the wound and cause bleeding, bruising, and secondary infections. In severe cases, the itching may lead to wounds or sores that warrant hospitalization or even surgical correction (5). Teens usually pick their acne lesions/pimples, which worsens the severity and can lead to scarring.

Compulsive behavior like skin picking can also lead to alteration to one’s appearance and cause a feeling of shame. Teens with permanently disfigured skin may resort to wearing clothes that cover their wounds or using makeup to hide their scars. In some extreme cases, they may isolate themselves and avoid social situations (5). They might have difficulty making friends and bonding with others. Therefore, awareness of possible social dysfunction is important among parents and caregivers.

Treatments For Skin Picking Disorder In Children

The treatment for skin picking disorder depends on the child’s motivation and readiness to address the problem. One or more of the following treatments could be followed (2) (10).

1. Placing barriers

• Using a band-aid can help prevent the child from picking the skin to an extent. You could also use a paint-on liquid bandage, which can help distract the child when they feel the urge to pick their skin.
• Although this approach may not help eliminate the habit, it can act as habit reversal training and prevent the child from acting impulsively.

Quick tip

Keeping nails trimmed and filed, using a softball or putting on mittens, and asking teachers or friends to stop them when they are doing it can help get rid of the habit (8).

2. Cognitive behavior therapy (CBT)

• It is the most successful treatment for skin picking.
• Cognitive behavioral therapy mainly focuses on teaching the child more effective ways to deal with stress and anxiety.
• It helps children find similar but less damaging behaviors to focus on.

3. NAC (N-acetyl-cystine)

• It is an over-the-counter ointment that can be effective on some children.
• It is a safe option as it is devoid of side effects.

4. Medications

• If the skin picking habit is triggered by anxiety and depression, selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, can effectively help manage the condition.
• Anticonvulsants such as lamotrigine have been shown to help with certain cases of skin picking disorders. Apart from this, antipsychotics may also be prescribed for children with comorbidities like bipolar disorder.

5. Acceptance and commitment therapy (ACT)

• This therapy is a combination of CBT and mindfulness techniques.
• It focuses on accepting emotions instead of suppressing them or resorting to coping mechanisms such as skin picking. You may also resort to support groups and family therapy to help the child.
• It helps in training the child to accept that they may experience negative emotions, and when they do, they need not succumb to self-destructive habits.

6. Habit reversal training

• This therapy focuses on making you more aware of your behavior by identifying when it occurs, how, and what triggers it.
• A therapist may then encourage you to perform an alternative behavior that is an incompatible substitute for the compulsive action.
• This helps reverse and replace unwanted behavior with a relatively safe, non-destructive substitute. 
• The relaxation and self-motivation techniques taught along with this therapy may help prevent the recurrence of unwanted behaviors in the future.

Infographic: Home Management Tips For Skin Picking In Children

Skin picking may be occasional or a habit, but it should be stopped to avoid scars and prevent it from becoming a disorder. So if your child picks their skin often, note some dos and don’ts from this infographic. These simple yet effective practices may help them overcome and resist the urge to pick.

Illustration: Momjunction Design Team

Illustration: Treatments For Skin Picking In Children Signs And Causes

Image: Stable Diffusion/MomJunction Design Team

Help your child stop body-repetitive behaviors like hair pulling and skin picking. Learn how to support your child in overcoming these habits.

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Reviewer Expert Author Editor Fact Checker

Dr. Deepak JakharMD

Dr Deepak Jakhar is a board-certified Dermatologist and Medical Director at Dermosphere Clinic, New Delhi, India, with over eight years of experience. He completed his MD from the prestigious University College of Medical Sciences, New Delhi.

Read full bio of Dr. Deepak Jakhar

• 
  Dr. Jared HeathmanMD Dr. Jared Heathman graduated from medical school at Texas Tech University Health Sciences Center and trained in child psychiatry and adult psychiatry at the University of Texas Medical Branch. He currently practices in Houston. Dr. Heathman has presented lectures on post-concussion syndrome, childhood depression, psychopharmacology (medications), ADHD, and personality disorders.
  
  Dr. Jared Heathman graduated from medical school at Texas Tech University Health Sciences Center and trained in child psychiatry and adult psychiatry at the University of Texas Medical Branch. He currently practices in Houston. Dr. Heathman has presented lectures on post-concussion syndrome, childhood depression, psychopharmacology (medications), ADHD, and personality disorders.
• 
  Elisa E. NebolsineLCSW Elisa Nebolsine is a therapist, author, and CBT specialist. Her therapy practice is based in Alexandria, Virginia, and is licensed in VA, MD, NY, MA, and DC. Elisa holds a masters degree in Clinical Social Work from Smith College.
  
  Elisa Nebolsine is a therapist, author, and CBT specialist. Her therapy practice is based in Alexandria, Virginia, and is licensed in VA, MD, NY, MA, and DC. Elisa holds a masters degree in Clinical Social Work from Smith College.

Dr. Ritika ShahBDS, CLC

Dr. Ritika Shah is a certified lactation counsellor (CLC) from iNational Health Care Academy, Singapore and a dental surgeon with more than seven years of clinical experience across various cities in India. She did her graduation in Dentistry from KM Shah Dental College.

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Rebecca MalachiBSc

Rebecca is a pregnancy writer and editor with a passion for delivering research-based and engaging content in areas of fertility, pregnancy, birth, and post-pregnancy. She did her graduation in Biotechnology and Genetics from Loyola Academy, Osmania University and obtained a certification in ‘Nutrition and Lifestyle in Pregnancy’ from Ludwig Maximilian University of Munich (LMU).

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Vidya TadapatriMSc (Biotechnology)

Vidya did her post-graduation in Biotechnology from Osmania University, Hyderabad. Her interest in scientific research and writing made her pursue a career in writing, in which she now has over five years of experience. She has done certified biotechnology-related training programs under renowned organizations such as Centre For Cellular & Molecular Biology and Department of Biotechnology.

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