Dermatillomania: Natural Remedies for Skin Picking

We all touch, from time to time, a small scab, a dry pimple, a peel that starts coming off. Normal. In people with dermatillomania, this ordinary gesture turns into compulsive behavior that lasts hours, leaves behind wounds, scars, infections and a deep shame hidden under long sleeves, thick makeup and pants even in summer. The condition, also called skin picking disorder or excoriation disorder, affects 2-5% of the population and belongs to the same family as trichotillomania: body-focused repetitive behaviors, or BFRB.

Our grandmothers saw women who examined themselves for hours before the mirror, who “dug at” every pimple, whose arms and legs were covered in scars. They gave them marigold ointments, urged them to occupy their hands with knitting or housework, prepared calming teas. The intuition was correct: keep hands busy, calm nerves, care for the skin. Today, research adds specific tools: N-acetylcysteine, habit reversal training, physical barriers, mindfulness. This guide brings it all together, with clear criteria for knowing when to seek professional support.

Table of Contents

• What is dermatillomania
• Symptoms and diagnostic criteria
• Causes of dermatillomania
• Natural remedies for body and nervous system
• Habit reversal training
• Skin care and scar prevention
• Daily support routine
• When specialized help is needed
• Frequently asked questions

What is dermatillomania

Dermatillomania, officially named in DSM-5 “excoriation disorder”, is a psychiatric condition in which a person repeatedly engages in picking, scratching, squeezing or tearing their own skin, resulting in visible lesions. Like trichotillomania, it is classified under obsessive-compulsive and related disorders. Typically starts in adolescence, often triggered by adolescent acne, and can persist for years or decades.

Most commonly affected areas:

• Face (acne, blackheads, “imperfect” skin).
• Arms, especially upper arms.
• Chest and back.
• Thighs, legs.
• Cuticles, fingers, palms.
• Scalp.

Objects of picking

The person may pick at:

• Natural scabs and crusts.
• Pimples, blackheads, whiteheads.
• Forming scar tissue.
• Apparently “healthy” skin, looking for “imperfections”.
• Hair follicles, even hairs under the skin.

Episode duration

Can last from minutes to hours, sometimes an entire evening or night. The person “loses themselves” in front of the mirror with an almost trance-like intensity. Time distorts. At the end come shame, exhaustion, lesions, sometimes abundant bleeding.

Symptoms and diagnostic criteria

DSM-5 criteria:

1. Recurrent skin picking resulting in skin lesions.
2. Repeated attempts to decrease or stop the behavior.
3. Significant distress or functional impairment.
4. Not caused by a substance (drugs) or other medical condition (skin disease without compulsive component).
5. Not better explained by another mental disorder.

Two patterns

Same as trichotillomania:

Automatic picking

• Occurs during monotonous activities.
• Without initial awareness.
• The person realizes when they see wounds or blood.

Focused picking

• Conscious, ritualized.
• Preceded by tension, mirror inspection, searching for “imperfections”.
• Followed by release, sometimes pleasure, then shame.
• May involve tools: tweezers, pins, long fingernails.

Warning signs

• Multiple scars of different ages, especially on arms, face, chest.
• Lesions that do not heal because they are repeatedly reopened.
• Repeated skin infections.
• Excessive use of concealer makeup, long clothing regardless of season.
• Avoiding pools, beaches, skin-exposing situations.
• Hours spent in the bathroom or in front of the mirror.
• Private dermatologist visits do not bring improvement.

Medical complications

• Bacterial infections (staph, strep).
• Permanent scars, keloids.
• Post-inflammatory hyperpigmentation.
• Severe cases: cellulitis, sepsis, deep scarring.
• Acne excoriee: severe form combining acne with compulsive picking.

Psychological complications

• Social anxiety.
• Depression, low self-esteem.
• Isolation: avoidance of intimacy, sports.
• Constant rumination about appearance.
• Frequent comorbidities: OCD, GAD, major depression.

Causes of dermatillomania

Genetic factors

Heritability estimated at 30-40%. Variations in the SAPAP3 gene (also involved in OCD, trichotillomania) increase vulnerability. Family history of BFRB or OCD is common.

Neurobiological factors

• Dysfunction of cortico-striato-thalamo-cortical circuits (as in OCD).
• Glutamate, serotonin, dopamine imbalances.
• Cerebral oxidative stress.
• Abnormal activity in the supplementary motor cortex.

Psychological factors

• Skin perfectionism.
• Intolerance of imperfection.
• Emotional regulation difficulties.
• Chronic anxiety, depression.
• History of severe acne.

Triggers

• Acute and chronic stress.
• Boredom.
• Activity monotony (TV, internet).
• Emotional discomfort.
• Looking in magnifying mirrors under intense light.
• “Imperfect” skin (pimples, scabs, inflamed follicles).
• Accidentally touching a small irregularity.

Natural remedies for body and nervous system

Remedy 1: N-acetylcysteine (NAC)

As in trichotillomania, NAC is the supplement with the best evidence for dermatillomania. A randomized study showed significant symptom reduction after 12 weeks at doses of 1200-3000 mg per day. Mechanism: glutamate modulation and oxidative stress reduction.

• Dose: 1200-2400 mg per day, split in 2 doses.
• Duration: at least 8-12 weeks.
• Caution: well tolerated. May cause gastric discomfort.

Remedy 2: Inositol

High-dose inositol has proven effects in OCD and BFRB. Mechanism relates to sensitization of serotonergic receptors.

• Dose: 12-18 g per day, starting with 2-4 g and increasing gradually.
• Duration: 6-8 weeks minimum.

Remedy 3: Omega-3 and vitamin E

For faster skin healing and inflammation reduction, omega-3 (2000 mg EPA+DHA) and vitamin E (400 IU) daily.

Remedy 4: Zinc

Zinc is essential for skin healing and cutaneous immunity regulation. People with dermatillomania often have sensitive skin and slow-healing lesions.

• Dose: 15-30 mg per day (with copper 1-2 mg for balance).

Remedy 5: Ashwagandha and magnesium

For the anxious component:

• Ashwagandha 300-600 mg morning.
• Magnesium bisglycinate 300-400 mg evening.

Remedy 6: Calming teas

• Valerian + passionflower in the evening.
• Lemon balm or chamomile during the day.
• Lavender, infusion or aromatherapy.

Habit reversal training

HRT is first-line psychological treatment, with proven 60-80% efficacy.

Step 1: Awareness

• Detailed episode journal.
• Identify moments, emotions, triggering situations.
• Observe precursor signs (the urge, the gesture of approaching the mirror, hand raising to face).

Step 2: Competing response

When the urge arises, perform an incompatible movement for 1-3 minutes:

• Clench a fist with hand in lap.
• Hold a tactile object: fidget toys, massage balls, beads.
• Knead putty, slime, therapeutic dough.
• Apply moisturizer (prevents fingernail contact).

Step 3: Motivational support

• Inform a close person.
• Reward successful days.
• Self-compassion after relapses.

Additional techniques

• Physical barriers: thin cotton gloves at night, patches on lesion areas, bandages, occasional surgical gloves.
• Reduce visual stimuli: eliminate magnifying mirrors, reduce intense bathroom lighting.
• Change routines: shower in soft light, do not inspect skin under spotlight.
• Bathroom distancing: do not approach mirror closer than 40 cm.
• Limited time: use a timer for skin hygiene and inspection (max 5-10 minutes).

Skin care and scar prevention

Gentle care routine

• Cleansing: alcohol-free, sulfate-free soap, lukewarm water.
• Hydration: rich cream 2-3 times a day. Lubricated skin is less “appetizing” for picking.
• Sun protection: SPF 30-50 daily, especially on scarred areas (to prevent hyperpigmentation).
• Do not use aggressive exfoliants, do not use tweezers to “extract” blackheads.

Treating existing lesions

• Apply healing ointments: calendula, aloe vera, panthenol, medical honey.
• For open wounds: cleanse with saline, apply mild antibiotic cream, adhesive dressing (hydrocolloid dressings are ideal, protect and accelerate healing).
• For old scars: dermocosmetics with retinols, niacinamide, vitamin C, tranexamic acid. Dermatologist can recommend peels, microneedling, laser.

Acne prevention (frequent trigger)

• Low-refined-sugar and low-industrial-dairy diet.
• For severe acne, dermatology consultation (topical or oral retinoids may be needed).
• Green tea (internal and external anti-inflammatory).
• Clay mask once a week.

Regular dermatologist visits

Not to treat every “imperfection”, but for:

• Detecting real problems (suspicious moles, infections).
• Removing large scars.
• Advice on suitable products.
• Professional empathy for the condition.

Daily support routine

Morning

• Gentle, quick hygiene (5-10 minutes max).
• Complete skin hydration.
• Balanced breakfast rich in protein and fiber.
• 4-7-8 breathing or 5 minutes of meditation.
• Ashwagandha with breakfast.

Day

• Occupy hands: writing, knitting, cooking, gardening.
• Avoid prolonged screen boredom.
• Active breaks every 2 hours.
• Constant hydration.
• Physical activity 30-60 minutes.

Evening

• Shower before dinner (avoid late bathroom episodes).
• Generous skin hydration.
• Valerian and passionflower tea.
• Calm activities: reading, audiobook, meditation.
• Cotton gloves at bedtime if you pick at night.
• Cool, dark, quiet bedroom.

Daily journal

• How many episodes today?
• What triggered them?
• What worked to stop them?
• How did I feel after?
• What will I try tomorrow?

When specialized help is needed

Consult a psychotherapist or psychiatrist if:

• Picking has lasted months/years and natural remedies have been insufficient.
• Lesions are severe, extensive, repeatedly infected.
• Depression, severe anxiety, self-harm thoughts appear. Call emergency services immediately.
• Picking limits social life, career, intimacy.
• Comorbidities exist: OCD, GAD, eating disorders.
• You have tried repeatedly and cannot succeed alone.

Cognitive behavioral therapy with HRT is first-line. Medication includes:

• N-acetylcysteine (first-line supplement).
• SSRI antidepressants (fluoxetine, sertraline, escitalopram).
• Sometimes low-dose atypical antipsychotics (olanzapine, aripiprazole) in severe cases.
• Lamotrigine has shown benefits in small studies.

A dermatologist is useful for treating cutaneous complications and often collaborates with the psychiatrist.

Conclusion

Dermatillomania is real suffering and, because it leaves visible marks on the body, is often accompanied by intense shame, isolation and low self-esteem. But it is treatable. The combination of natural remedies (NAC, inositol, magnesium, ashwagandha), behavioral techniques (HRT, physical barriers, competing response), gentle skin care and, when needed, professional support, provides concrete recovery tools. Skin heals remarkably well when given respite. Old scars fade. Sense of control grows. Social life opens up. No one needs to hide under long sleeves forever.

Frequently asked questions

1. What is the difference between dermatillomania and acne excoriee? Acne excoriee is a particular form of dermatillomania in which the person has real acne (as a dermatological condition) but reacts compulsively to every pimple, transforming it through picking into a much more severe lesion than it would have been naturally. Treatment combines dermatological acne management (topicals, retinoids, sometimes isotretinoin) with psychological intervention for compulsive picking. It is a clear example of the dual cutaneous and psychiatric dimension.

2. Will I have permanent scars? Depends on the severity and duration of the behavior. Superficial lesions, treated appropriately without repeated picking, often heal completely in 2-6 weeks, sometimes with transient hyperpigmentation that fades in months. Deep or repeated lesions can leave permanent scars, atrophic (sunken) or hypertrophic (thickened). Modern treatments (fractional laser, microneedling, chemical peels) can significantly reduce scars, but complete healing after years of picking is rarely possible.

3. Can I practice mindfulness even if I cannot concentrate? Yes, and dermatillomania is exactly the context where mindfulness helps the most. It is not about perfect concentration but about training awareness of what happens in body and mind. Start with 3-5 minutes a day using a guided app. Observe without judgment urges, emotions, tensions. You do not fight the urge to pick, you observe it and let it pass. After a few weeks, you will notice you can “catch” the hand before it reaches the face.

4. Do contraceptives worsen dermatillomania? Indirectly, yes, if they cause hormonal acne. Some contraceptives with more androgenic progestogens (levonorgestrel) can worsen acne. Others (drospirenone, cyproterone) improve it. If dermatillomania is closely linked to acne, discuss a change with your gynecologist. For many patients, treating acne with appropriate combined contraceptives also reduces picking frequency.

5. Do I need to give up makeup? No, but use it consciously. Concealer covers lesions and scars, which temporarily reduces social discomfort. On the other hand, applying makeup in front of a magnifying mirror under intense light is a frequent picking trigger. Solutions: use makeup quickly in soft light, avoiding prolonged inspection; choose non-comedogenic products that do not worsen acne; remove gently in the evening without excessive rubbing.

6. Can children have dermatillomania? Yes, it can start in childhood (7-8 years), though rarer than in adolescents. Pediatric approach is specific: evaluation for real dermatological problems (atopic dermatitis, eczema, acne), age-appropriate behavioral therapy, parental involvement without punishment, alternative hand occupations, sometimes school support. Medication is rarely used and only in severe cases with close monitoring.

Professional warning

The information in this article is educational and does not replace professional evaluation and treatment. Dermatillomania is a recognized psychiatric disorder that in moderate-severe forms requires interdisciplinary collaboration: psychiatrist, psychotherapist with BFRB expertise, dermatologist. For infected lesions (extensive redness, pus, fever), medical consultation is urgent. If severe depression or self-harm thoughts appear, call emergency services immediately. The supplements mentioned can provide support but should be used after consulting a health professional, especially if you take other medications or have preexisting medical conditions.