Review article
Dermatillomania. Symptoms, course and consequences of pathological skin picking

Dermatillomania or pathological skin picking (PSP) is defined as repetitive, ritualistic picking of the normal skin which results in tissue damage. Pathological skin picking is not recognized as a distinct psychiatric disorder in the International Classification of Diseases, 10th Revision (ICD-10), but it is currently classified as an impulse control disorder not otherwise specified or obsessive–compulsive spectrum disorder. Pathological skin picking often begins in adolescence but some studies have reported the age of onset between 30 and 40 years. Although prevalence of PSP is unknown, it is estimated that 1.4% of the general population meet the criteria of picking with noticeable skin damage or with associated distress. Many studies indicate that pathological skin picking is a heterogeneous condition, and it is possible to differentiate at least two styles of picking: the focused style involves picking with full awareness often in response to an urge or negative effect, whereas the automatic style occurs beyond one’s awareness, often in sedentary situations. Pathological skin picking is associated with psychosocial impairments, social isolation, distress, and high levels of anxiety and depression, and it often leads to serious medical complications, i.e. recurrent infections. Pathological skin picking is a chronic disorder with a high rate of psychiatric comorbidity. Individuals with skin picking disorder have a high incidence of anxiety disorders, mood disorders, body dysmorphic disorder and impulse control disorders other than PSP.