Skin Picking as a Symptom of Autoimmune Disease

Skin picking disorder (dermatillomania or excoriation disorder) and autoimmune disorders often go together. With skin picking, you have a compulsive urge to pick, scratch, rub, pull, or scrape your skin. It can continue beyond the point of causing pain and creating sores to being a significant problem.

In some people with autoimmune diseases, skin picking symptoms may become a habit and a sign of a mental health disorder. 

This article looks at autoimmune disorders that cause skin picking, treatments, and prevention.

Which Autoimmune Disorders Can Cause Skin Picking?

With autoimmune diseases, the immune system attacks healthy tissues, mistaking them for pathogens like viruses or bacteria. 

The targeted tissues are different in each disease, but many of them have similar symptoms, affecting the skin in some way. Some autoimmune disorders tied to skin picking are:

• Dermatomyositis: A skin rash plus muscle inflammation
• Hashimoto’s thyroiditis: Dry, coarse, splitting skin that doesn’t heal well
• Lupus: Itchy lesions on the calves and tips of fingers and toes.
• Multiple sclerosis (MS): Crawling sensations on the skin that trigger an urge to scratch
• Psoriasis/psoriatic arthritis: Itchy plaques on the skin are raised, discolored, and scaly
• Rheumatoid arthritis (RA): Joint inflammation may cause the skin to itch
• Type 1 diabetes: Skin lesions (sores) and slowed healing

Some research suggests itchiness is a persistent symptom of many autoimmune connective-tissue diseases and is under-recognized and undertreated. This could make them prone to triggering excoriation.

Signs and Symptoms of a Skin Picking Disorder

Symptoms of skin picking disorder include:

• Recurrent skin picking that leads to skin lesions
• Repeated attempts to stop the behavior
• Significant distress or impairment due to picking
• An urge to pick or physical tension that’s relieved by picking
• Unusual sensations (bumps, sore spots)
• Beliefs about how the skin should look or feel

To be diagnosed with skin picking disorder, your symptoms can’t be better explained by another psychiatric disorder and aren’t caused by another medical condition, a skin condition, or a substance (like a medication).

Effects and Complications of Skin Picking Disorder

People with skin picking disorder often pick at multiple places on their bodies that may change over time. They try to cover up the sores created from picking with makeup or clothing.

This disorder may also lead to avoiding situations like swimming, wearing shorts, or being intimate because people feel shame or don’t want others to know. Some even hide this condition from their healthcare providers.

Medically, skin picking can lead to:

• Open wounds
• Infections
• Scabbing and scarring
• Skin discoloration

Emotionally, it can result in social isolation, depression, and anxiety disorders.

Skin Picking Disorder Treatment

Treatment for skin picking disorder tied to autoimmunity should involve multiple approaches.

Autoimmune Disorder Treatment

It’s crucial to treat the autoimmune disease. This can help alleviate the symptoms that led to skin picking in the first place.

Autoimmune disorder treatments vary by disease but may include:

• Immunosuppressant or immunomodulant drugs
• Anti-inflammatory drugs
• Pain medications
• Hormone therapy (type 1 diabetes, Hashimoto’s thyroiditis)
• Arthritis medications (biologics and disease-modifying antirheumatic drugs)
• Nutritional supplements
• A healthy diet
• Appropriate exercise and activity
• Physical therapy, massage, and other complementary treatments

Skin Damage Treatment

The damage from skin picking can be treated as follows:

• Antibiotics can treat infections.
• Healing can be promoted with compresses, bandaging, topical retinoids, and topical steroids.
• Scars may be removed with cosmetic procedures.

Mental Health Treatment

Mental health treatment is usually necessary to stop the picking behavior. Therapies that may be effective include:

• Cognitive behavioral therapy (CBT)
• Habit reversal therapy (HRT)
• Medications such as antipsychotics or selective serotonin reuptake inhibitors (SSRIs, a type of antidepressant)

Breaking the Skin Picking Habit

You can take a few steps to help break yourself of the habit of picking your skin. Whether it’s caused by dry skin, an itch, boredom, stress relief, blemishes, or something else, you'll need to figure out what makes you want to pick. That can help you change habits or seek the right kind of treatment.

It also can help to make picking harder. This strategy is called stimulus control. It may involve the following:

• Keeping fingernails extremely short
• Wearing long-sleeved shirts
• Wearing gloves at times when picking is likely
• Distracting your hands with stress balls, silly putty, or fidget toys

Prevention

As awareness of skin picking in autoimmune disorders grows, healthcare providers may start looking for it routinely. This may help prevent it or catch it early on.

You can prevent the condition from developing—which can also prevent complications—by recognizing early symptoms and getting medical help for them.

Once you’ve been successfully treated, you can prevent relapses by sticking to your treatment regimen, monitoring yourself for a return of symptoms or habits, and talking to your healthcare team if you notice anything concerning.

Summary

Skin picking disorder is related to several autoimmune diseases, including rheumatoid arthritis, psoriasis, lupus, MS, and type 1 diabetes. Skin picking disorder involves an urge to pick, scratch, scrape, or pull the skin and an inability to stop these behaviors. Treatment generally involves medications for the autoimmune disease, wound care, and mental health interventions.

A Word From Verywell

It’s normal to feel shame over a condition like skin picking disorder, but you don’t have to live with that feeling or the effects of the condition. Reversing the behavior starts by informing your healthcare provider. Medical attention can keep your condition from worsening and can get you on the road to feeling better.