Phenomenology and Epidemiology of Pathological Skin Picking

Pathological skin picking (PSP), or neurotic excoriation, is characterized by the repetitive and compulsive picking of skin, causing tissue damage. It appears to have a prevalence rate of 1.4%-5.4% in the general population and is seen predominantly in females in clinical settings. Individuals with PSP may pick for hours each day, resulting in significant scarring, infections, and medical complications. Although PSP is common, most individuals with this disorder are unaware of treatment options and thus often do not seek treatment. Co-occurring psychiatric conditions are common in PSP, with depressive, anxiety, and obsessive-compulsive disorders presenting as the most prevalent conditions. Significant psychosocial impairment and activity avoidance due to shame and embarrassment are frequent. Neurocognitive research has recently shown that individuals with PSP have deficits in inhibitory control, a finding similar to that found in trichotillomania. From a public health perspective, concurrent collaboration between dermatology and the behavioral sciences is imperative for future advances in the understanding and treatment of PSP.