If Skin Picking Is Especially Hard to Manage Right Now, You’re Not Alone
How to address excoriation disorder during extreme stress.
I thought the office was empty, but it wasn’t. I turned a corner and found a lone coworker with an embarrassed look on his face. He, too, thought he was alone, so he’d picked at a pimple on his face, which was now bleeding. I felt his pain, since at the time I was suffering from the worst bout of adult acne I’d ever had. My one reprieve was going to the office each day, where I had no choice but to keep my hands off my face.
After countless workers began working from home this spring, my friends have gradually revealed that they’re all struggling with the same issue—they can’t stop picking at their faces. And who can really blame them? Tensions are high, to say the least, and recent events are triggering more cortisol (your fight-or-flight hormone) to flood our systems and incite stress responses, like excoriation disorder.
Also known as chronic skin picking or dermatillomania, excoriation disorder is related to obsessive-compulsive disorder and involves repeatedly picking at the skin, which can cause painful lesions as well as a disruption to daily life. Not all forms of skin picking fall into this more serious category—in fact, most don’t—but expert insight into both the causes and healing process can help anyone compulsively picking at their skin, hair, nails, or scabs begin to move forward on the path to recovery.
The Root of the Problem
Stress, stress, and more stress. Dr. Nancy Irwin, a licensed clinical psychologist, confirmed that the immense amount of stress and anxiety many people are experiencing right now are playing a two-pronged role—they can both cause acne to develop and drive the desire to pick. Dr. Irwin noted that stress is behind about 72 percent of all illnesses and conditions, skin related or not. “As the skin is our largest organ, it can hold clues as to what the person is feeling about the self and/or life at the current time,” Dr. Irwin explains. The negative effects of stress on skin can manifest in conditions like acne, dandruff, itchy skin, and even hair loss. Stress can also cause flare-ups of skin issues such as psoriasis and rosacea to occur.
She notes that skin picking can become a compulsion if you do not identify the root of the problem, as well as make lifestyle changes that help you better manage your stress levels. Having a positive support system and making time for fun and self-care are a good place to start. These can involve exercising and eating healthy, enjoying leisure activities, or practicing your faith or meditation. We all have varying degrees of stress and challenges, so Dr. Irwin encourages patients to have a “go-to” list of how you can self-soothe and process those stressors when they present themselves. “Work on building up trust in yourself that you have everything you need to weather the current challenges.”
Stopping the Urge to Pick
We know that picking at acne lesions, dry skin, or any part of our bodies can damage the skin, resulting in hyperpigmentation, multiple forms of scarring, disfigurement from lesions, and open wounds that might lead to further infection. Stopping the impulse to do so is easier said than done, however. “Everything has a positive intent, and picking is a relief of anxiety,” Dr. Irwin clarifies. But that doesn't mean it’s a healthy coping mechanism, “[Patients that pick] are avoiding the issue [causing their stress] and compounding the belief that there is no other way to manage the pain or issue at hand.”
One tactic for managing the urge to pick that Dr. Irwin recommends is asking yourself empowering questions like If I were able to handle this stress in my life while respecting my body, how would I do so? Who do I know that can help me? Another is seeking the counsel of those who have overcome picking-related struggles, such as in a support group. “You are not alone. There are millions of others who have suffered this and overcome it. They can be excellent resources for you.” If you are looking for professional help, Dr. Irwin suggests working with a therapist who concentrates in this area.
Healing the Damage
Skin-picking disorder impacts as many as one in twenty people, with women being more commonly affected than men. After you identify the source of your stress and anxiety and seek treatment, the next step is healing the preexisting damage. Dr. Annie Chiu, board-certified cosmetic and general dermatologist, concedes that right now is an especially hard time to stop picking at your skin. She explains that stress weakens our skin barrier, which is why most skin conditions (like acne and psoriasis) tend to flare up during those moments. More lesions means you have more opportunities to pick. “When you have good skin, it’s just not as tempting,” she notes.
We’ve all tried to pop the occasional pimple that we should have left alone, and watched it heal slower as a result, but serious cases of excoriation disorder can lead to more serious damage, like tissue injury, scarring, and discoloration. To heal the physical effects of picking or more extreme cases of excoriation disorder, Dr. Chiu recommends using a gentle facial cleanser followed by a soothing balm or serum to maintain skin hydration. She suggests reaching for any occlusive protectant (aka slippery balm-type products) like Aquaphor to help skin cells heal faster and create a protectant barrier. Look for ingredients such as ceramides, niacinamide, or hyaluronic acid, all of which can help build skin-health barriers. She also recommends incorporating overnight moisturizing masks and sheet masks into your skin-care routine—but be sure not to go overboard on new products, as tempting as it can be to try everything under the sun.
To address the breakouts themselves, Dr. Chiu is a fan of acne patches to cover the zit, such as COSRX Acne Pimple Master Patch, which physically blocks you from picking and contains acne-fighting ingredients like tea tree oil and salicylic acid. Says Dr. Chiu, “If we’re actively conscious we’re taking care of our skin, we are not going to be as prone to want to ruin that.” For those looking to heal deeper scarring, there are also in-office solutions such as cortisone injections and laser treatments. Your dermatologist will be able to recommend the best course of action depending on your current skin condition.
Below, five of our favorite products to help heal breakouts, soothe the skin, and repair damage from previous picking.
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