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DERMATILLOMANIA- Skin picking disorder




1. Definition (Description, Appearance)

The term "dermatillomania" originates from Greek and translates to “passionate skin picking.” The disorder, also known as excoriation disorder or “skin picking,” spans both dermatology and psychology. Those affected feel an uncontrollable urge to manipulate their skin, categorizing dermatillomania as an obsessive-compulsive ( OCD) or impulse control disorder. Skin manipulation behaviours include picking, scratching, and squeezing, often leading to wounds and impaired healing. Many affected individuals feel ashamed of their behaviour, which they find difficult to control.


2. Epidemiology (Prevalence, Gender, Age)

It’s estimated that 3-5% of the population experiences dermatillomania during their lifetime, with women particularly affected. The condition often begins around puberty, with a significant portion of skin picking focused on the face, though any part of the body can be affected, including the scalp, legs, arms, chest, and back. Less commonly, skin manipulation may occur on the pubic area, feet, or ears.


3. Etiology (Causes, Triggers)

Triggers for skin picking vary widely and are highly individual. While many engage in the behaviour to relieve stress or attain a sense of relaxation, perceived skin irregularities can also prompt picking. Blemishes, skin irritations, scabs, skin flakes, or other lesions often serve as triggers. The underlying motivation is often to make the skin feel smoother, though the behaviour is frequently automated and almost unconscious.


4. Symptoms and Course of the Disease

Dermatillomania is marked by compulsive skin picking, often resulting in pronounced lesions and wounds, particularly on accessible areas like the face. Affected individuals usually struggle to control this behaviour, leading to feelings of shame that may result in social withdrawal. Concealment is common, with individuals opting for high-necked clothing or makeup to hide affected areas. They may also avoid activities where skin damage might be visible, such as swimming or well-lit events. Severe dermatillomania can cause significant scarring, infections, delayed wound healing, and even sepsis.


5. Differential Diagnosis

Dermatillomania should first be distinguished from skin conditions associated with inflammation and lesions, such as severe acne. It’s also important to note that individuals with skin-picking disorder may experience other conditions, particularly obsessive-compulsive disorders, anxiety, or depression. Dermatillomania is sometimes associated with related disorders, including onychotillomania (nail picking), trichotillomania (hair pulling), and cheilitis factitia (lip biting).


Acné excoriée des jeunes filles is now classified as dermatillomania; in this condition, mild acne or skin irregularities become exacerbated by self-manipulation, leading to severe inflammation.


6. Medical Therapy

Diagnosis requires sensitivity and empathy, as there is a high risk of false negatives due to coexisting, more familiar conditions that may overshadow the primary issue. Once diagnosed, both dermatological and psychological perspectives are essential, as dermatillomania spans both fields. Cognitive behavioural therapy (CBT) has proven effective in addressing the condition. This approach involves psychoeducation, self-monitoring, strategies to reduce picking, and targeted relapse prevention, including an emergency plan. From a dermatological standpoint, improving skin conditions may reduce triggers for picking, scratching, and squeezing.


7. Recommendations for the Beautician

If skin picking is suspected, beauticians should proceed with care. It’s crucial to avoid stigmatizing or judging clients with this mentally taxing condition. An empathetic, understanding approach has shown to be effective.

Beauticians can also play a pivotal role in enhancing skin condition through tailored treatments, positively supporting therapeutic outcomes and potentially reducing triggers.

Based on the client’s specific skin concerns, beauticians might recommend products that address impurities or offer personalized skincare solutions that intensively nourish the skin, creating a pleasant feel.

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