Incidence and clinical presentation
Skin picking disorder usually starts in adolescence, when acne can be a trigger, but in some people the onset of the disorder is not until well into adulthood. The condition also occurs in children (1). The point prevalence is reported to be between 1.9–2.1 % and lifetime prevalence between 3.1–5.4 % (5, 6). More women than men seek treatment, but screening studies suggest a less pronounced difference between the sexes with approximately 55 % women (5). Comorbidities are common, particularly generalised anxiety disorder and depression (5). Low scores on physical and mental health quality of life measures seem to apply irrespective of comorbidities (6).
The picking often starts by the patient examining their skin, including in the mirror, or feeling irregularities in the skin. Some patients report that they often pick entirely healthy skin. A distinction is usually made between two forms of skin picking, with patients alternating between these. Automatic skin picking occurs more or less unconsciously and alongside activities such as driving, watching TV or reading (1). Focused skin picking is more conscious and often accompanied by a form of urge. This may be the idea that irregularities like scabs, lesions or pimples must be 'got out' or removed, or a physical feeling of skin itching or tingling. All accessible skin surfaces are affected, particularly the face, hands, fingers and arms. Some people use instruments, for example tweezers or needles. Skin picking or camouflaging lesions and scars is time consuming, and some people spend several hours daily (1).
Sick leave and problems in work, school and social situations are common (1). Other consequences are infection and chronic lesion and scar formation, as well as musculoskeletal pain. The disorder is associated with shame and avoidance behaviour. Some people isolate themselves, and suicidal ideation is not uncommon (1).