Excoriation Basics

Excoriation disorder is characterized by recurrent picking at one's skin to the point that damage or discomfort is caused. This guide outlines how excoriation disorder affects children and how it's diagnosed and treated.

Excoriation: What Is It?

Excoriation is a disorder characterized by recurrent skin picking, resulting in skin lesions. Some children with the disorder say that picking at their skin makes them feel good, but not all children affected by the disorder do it intentionally, or consciously; some may not even remember doing it. Excoriation can cause psychic pain in the form of shame and embarrassment, and lead to blemishes, scabs, infection at the site of the picking, and tissue damage. Onset is most often around puberty.

Excoriation: What to Look For

Marks or scabs on the body from a child possibly picking his own skin are key signs that he may be affected by excoriation. The face is the most common target, but young people also pick at arms, legs, back, gums, lips, shoulders, scalp, stomach, chest, fingernails and toenails. Some children pick at one particular part of the body repeatedly, and others “rotate” to allow the previous part of the body to begin to heal. Skin picking is generally done with just a child’s own fingers, though it is not unheard of for children to use tweezers or other implements. Skin picking can be triggered by anxiety or stress, and provide children with a feeling of relief. But the child may experience guilt, shame, and embarrassment about his habit, and attempt to hide or cover up both the act and the resulting evidence of it in the forms of marks or scabs.

Excoriation: Risk Factors

Children who have obsessive-compulsive disorder, or who have first-degree family members with OCD, are more likely to develop the disorder. Girls are also more at risk.

Excoriation: Diagnosis

To meet the criteria for excoriation disorder a child must be engaged in recurrent skin picking that produces skin lesions, he must have made attempts to cut back or stop the behavior, and the skin picking must be causing him significant distress or impairment in his functioning.

Excoriation: Treatment

Treatment for excoriation will most likely include psychotherapy and may include medications. Cognitive behavior therapy (CBT) in particular can help a child become more aware of her skin picking and begin to recognize the emotions and mental states that are likely to trigger it. Over time, with professional help, the habit of skin picking can be reversed. Medication is usually not the first choice in treating excoriation, although antidepressants like SSRI’s may be prescribed while a child participates in cognitive behavior therapy.

Excoriation: Risk For Other Disorders

Excoriation often occurs along with trichotillomania (hair pulling), OCD and major depressive disorder.