Skin picking disorder: unpicking a topical issue

Despite being first reported in the medical literature in 1875, pathological picking of the skin remains poorly understood, under-diagnosed and, in many cases, inadequately treated. Previously coined terms include ‘neurotic excoriations’, ‘dermatillomania’, ‘psychogenic excoriations’, ‘acne excoriee’ and ‘pathological skin picking’. In 2013, skin picking disorder (SPD) was formally recognised as an independent condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM- 5) (See Box 1). SPD is estimated to occur in 2–4% of the population and is characterised by recurrent picking of the skin, resulting in persistent skin lesions. With less than 20% of afflicted patients feeling their clinician ‘knew much’ about their condition, it is imperative that knowledge, screening and awareness of SPD is raised, to ensure medical professionals can provide optimal care for their patients. This is particularly important given the often marked psychological distress which may be associated with the disorder, and the potential for serious psychiatric and medical complications.