Scabs, scars, red-raw welts and an undeniable urge to scratch, pick, and peel – this is the skin of someone struggling with dermatillomania.

While the causes behind dermatillomania, also known as excoriation disorder, are complex, an unexpected side effect of the coronavirus pandemic is that it has triggered and worsened skin picking, alongside a fresh fear over how the behaviour’s resulting open wounds and constant touching could put sufferers at increased risk of catching Covid-19.

It’s hard enough not to react to warnings about touching your face by immediately touching your face – now imagine you have a compulsive disorder that can make it feel impossible to stop poking, scratching, and picking.

Being confined to the home, no longer going out to a workplace or to see friends or family, allows the secretive habit of skin picking to thrive.

Warning: this article contains descriptions of skin picking behaviours that some may find triggering.

What is dermatillomania or excoriation disorder?

Excoriation Disorder, also known as skin picking disorder or dermatillomania, is characterised by the repetitive picking of one’s own skin. Individuals who struggle with this disorder touch, rub, scratch, pick at, or dig into their skin in an attempt to improve perceived imperfections, often resulting in tissue damage, discoloration, or scarring.

Skin picking disorder is one of a group of behaviors known as body-focused repetitive behaviors (BFRBs), self-grooming behaviors in which individuals pull, pick, scrape, or bite their own hair, skin, or nails, resulting in damage to the body.

You may be struggling with dermatillomania if you:

• cannot stop picking your skin
• cause cuts, bleeding or bruising by picking your skin
• pick moles, freckles, spots or scars to try to ‘smooth’ or ‘perfect’ them
• do not always realise you’re picking your skin or do it when you’re asleep
• pick your skin when you feel anxious or stressed

The TLC Foundation and NHS.

James, 26, has experienced dermatillomania since he was very young, believing it was initially triggered by a move to China at the age of eight and encountering more mosquitos.

‘As a nail biter already I didn’t have the best impulse control,’ James says. ‘This transferred to itching the bites, and then picking the scabs.’

James’ urge to pick focuses on his legs and around his mouth. He has been going to therapy since last October to manage the severe anxiety for which skin picking feels like a coping mechanism.

James was due to get married in April and had a goal of having his skin picking under control by then. When the pandemic caused his wedding to be cancelled, the loss of a target resulted in a relapse.

Since lockdown began, he’s noticed an increase in skin picking due to no longer being surrounded by other people.  

‘When I’m in the office, it’s a lot easier to feel like someone is judging me for picking my skin, so I don’t do it purely based on that,’ he explains.

Sarah*, 26, has a similar experience, finding that the lack of public outings means there’s nothing to stop her picking at the skin on her feet until it bleeds.

‘I have always bitten and picked at my cuticles and nails, but as of a few years ago (coinciding with the onset of anxiety and depression in university) I started pulling out the hair on my head and other parts of my body, and picking at the skin on my feet,’ Sarah tells us.

‘I realised it was a problem when I would compulsively pick my feet until they bled very regularly, rarely giving them a chance to heal, which felt fine and even important to do at the time but would make it very difficult to walk the next day. I used to also cut off calluses with small blades sometimes which would leave my feet raw and bleeding too.

‘I think my anxiety and focus has narrowed in lockdown and I have fewer outlets, which has made the picking worse. I also don’t need to go anywhere, which means the consequences of damaging my feet are less severe and I do it more.’

Those with dermatillomania can experience skin picking as intensive, focused sessions, spent staring in a mirror and scratching small spots into painful craters, or it can occur as a mindless habit, with the sufferer not even conscious of what they’re doing.

Both types of skin picking can be incredibily difficult to deal with, and both are able to flourish in the scenario of lockdown.

Boredom and isolation easily allows for mindless picking without the fear of knowing people will see the inflamed bumps and red-raw marks to snap you out of the trance.

Being furloughed, missing your usual commute, and working from home all gives you more time alone with your body, your hands, and any tools – the magnifying mirror, tweezers – and it’s easy to find yourself having spent hours digging into your face in pursuit of smoothing out a blemish that was barely noticeable to begin with.

Then there’s the heightened anxiety and stress associated with the simple fact of living in a pandemic, which makes picking away feel all the more irresistible.

‘A big factor is the constant access to mirrors,’ Chloe, 29, says. ‘I’m also on furlough now which means I have lots of time on my hands.

‘Sometimes I can lose an hour just sitting in front of the mirror inspecting my face for flaws and imperfections, picking and squeezing at things that I doubt anyone else can even see.

‘Sometimes my boyfriend will be talking to me and all I can think about is going to pick or squeeze an imperfection that I’ve noticed.’

Being able to spend unlimited time outside has been hugely beneficial for Chloe.

‘I find the good weather really helps me because I can go and spend time outdoors (on my balcony or socially distancing in a park) and I forget all about it and just enjoy feeling the sun on my face,’ she explains. ‘I think it’s just a great distraction.’

Distraction and keeping the hands and mind busy are essential tools in avoiding a compulsive skin picking binge, and make maintaining a routine and filling time all the more vital in lockdown.

While Chloe has found a skincare routine helpful and James likes to doodle, Emma, 29, has created her own jewellery collection, Worry Knot, specifically designed to help her deal with skin-picking behaviours.

‘I first started picking my face as a teenager around the age of 17 when I first got spots but I would sit for hours in front of the mirror every day,’ Emma tells us. ‘A year or 2 later, I moved on to my thumbs more than my face and since then, for the past 12 years I have been picking both but mainly my thumbs.

‘My face and thumbs are really scarred from 12 years of damage done and most days I have to wear plasters on my thumbs, which covers them up and stops me from picking as much.

‘My anxiety has peaked in lockdown because I lost my part-time job and my grandma all at the beginning of lockdown.

‘I was very emotional and coronavirus has caused a lot of uncertainty and I have been inside, in front of mirrors or the TV, when I do most of my skin picking. Not getting out much is definitely bad for my skin picking.

‘I use my own jewellery to help me keep my hands busy. They are designed to be twirled and played with like Greek worry beads.

‘I would be absolutely lost without it especially during lockdown.

Counselling Directory member and therapist Deshara Pariag echoes the benefits of self-soothing techniques that can pull you out of the skin picking cycle – when you see an imperfection, try to smooth it by picking, and end up with a mark or blemish that can’t heal because you can’t stop scratching away.

Deshara tells us: ‘I advise my patients to use coping techniques such as squeezing a ball to release tension, stress or anxiety, and placing sticky notes in areas at home where the patient is prone to pick their skin, such as the bathroom mirror.’

Deshara notes that it’s crucial to tackle the root cause of dermatillomania and identify underlying anxiety or worries.

But while we’re in lockdown, seeking new treatment can feel even more challenging. Virtual and over-the-phone therapy is available and medical appointments are permitted amid the pandemic, but when we’re cooped up indoors and spending so much of our time in isolation, self-help techniques take on a huge importance.

If you’re struggling, try to identify when skin picking occurs so you can figure out your triggers and deal with them directly.

Do you pick absentmindedly when you watch TV? Try filling your downtime with more actively engaged activities like reading, baking, or board games, or pick up a new handy-busying habit that you can do while getting lost in a film (knitting, doodling, fidget-spinning, whatever works to keep your nails digging into your skin).

Do you find the sight of dry skin impossible to ignore? Load up on lotions to keep your skin hydrated and smooth. File your nails. Moisturise your cuticles whenever you feel the urge to peel or chew them off.

Are you often finding yourself up late and in a worry spiral, dealing with scary thoughts by zeroing in on an ingrown hair? It’s time to go through that worry spiral and fact-check the worst-case scenarios you’re imagining.

Things to try if you’re struggling with skin picking:

• keep your hands busy – try squeezing a soft ball or putting on gloves
• identify when and where you most commonly pick your skin and try to avoid these triggers
• try to resist for longer and longer each time you feel the urge to pick
• care for your skin when you get the urge to pick it – for example, by applying moisturiser
• tell other people – they can help you recognise when you’re picking
• keep your skin clean to avoid infection
• do not let your nails grow long – keep them trimmed
• do not keep things like tweezers and pins where you can easily get at them

NHS

Alice, 24, has struggled with picking at the skin on her fingers since her teens. In lockdown, in part prompted by the resulting sting of hand sanitiser on her wounds, she’s realised just how much she needs to take the time to treat herself with care.

‘A lot of the time I find that I don’t even realise I’m picking at my skin, so trying to be aware of it is helpful to know when to stop,’ she says.

‘One of my colleagues and friends has helped me to curb the habit at work, we regularly remind each other to stop picking at the skin on our fingers in the office. Now I’m working from home I don’t have someone there to point it out, so I don’t realise I’m doing it a lot of the time.

‘My boyfriend would regularly remind me to stop skin picking too at home but we had to lockdown separately so there’s been less support through others.

‘I’m making sure to take time for myself in lockdown. I find working out and doing exercise positively impacts my mental health so I make sure to get outside and do something every day, whether that’s a walk, run or cycle ride.’

There’s a lot of shame and embarrassment associated with the physical results of dermatillomania as well as being unable to stop doing something that just doesn’t make sense to an outside observer.

Don’t let that prevent you from getting support, whether that’s in an online forum, a chat with a therapist, a GP appointment, talking with your family, or just getting your housemate to say ‘oi, stop that’ when they notice you scratching.

And be kind to yourself. It sounds silly, but that’s kind of a huge deal when your mental health issues manifests in an act that causes you physical harm.

Treat yourself gently, ask yourself what you need right now to feel more comfortable, and fill your hands and time with things that soothe your mind.

*Name has been changed.

Need support? Contact the Samaritans

For emotional support you can call the Samaritans 24-hour helpline on 116 123, email [email protected], visit a Samaritans branch in person or go to the Samaritans website.

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