Speaking from experience as a skin picker and hair puller – behavior has a purpose. Until you find and address the purpose, changing the behavior is going to be a challenge, to say the least. It’s so much easier to modify the habit if you know the purpose so you can find an effective substitute. Please be kind to yourself. You don’t lack the desire or willpower, it’s not “just a bad habit” – it’s a suboptimal coping tool. So the question becomes, what are you coping with?
Causes to consider:
- Keratosis Pilaris (Chicken Skin): Pictures, Causes, and Treatment (healthline.com) (lotion with lactic acid is the standard treatment)
- viral lesions (chicken pox, shingles, herpes) – hydrocolloid patches work for these
- itching instead of pain (my shoulders tend to itch when subluxated so my hands end up scratching there a bunch)
- seams or tags in clothing
- stimming (link post pain dopamine for motivation info)
- self soothing – Once I started paying attention to when and where I was picking I noticed I would start with rubbing my arms or scalp during challenging interactions, find a bump, scratch it until smooth (even if bloody)
Alternatives to substitute:
- Applying balm or patches
- wear clothing inside out
- scratching with a tool or gloves to not feel the things to scratch at
- treat the underlying cause
- Ideally, identify the allergy and remove the allergen. That can take a while, so in the meantime try allergy medication like Lortadine (caution with regular use of Benadryl – Alzheimer’s or dementia link) or a topical anti-inflammitory
- lotion with lactic acid is the standard treatment, also try exfoliation
- hydrocolloid patches work for these, you can also try the reusable silicone ones, medication like Valtrex or supplements like lysine (find link)
- regular gentle (wedges or drop table to use gravity/gentle pressure, not the big crunch style) chiropractic care, bracing, strapping or taping as you’re able to support the joints
- wear clothing seams out, cut out tags
- I use a variety of hairbrushes, toothbrushes and massage tools (to link)
- I try to wear gloves so I can still massage myself, but don’t feel the spots so the picking doesn’t start. I also use many of the same tools as for stimming.
Understand your triggers.
There are so, so many different factors that can set off picking, from anxiety or depression, to dermatologic conditions like acne or ingrown hairs, to boredom or having idle hands.6 Expert Tips for Coping with Skin Picking Disorder | Apartment Therapy
Boredom means your brain wants more stimulation – stimming. Idle hands is stimming or self-soothing – I dislike the use of these as to me it implies you should be doing something productive. If knitting, crochet or macrame work for you then great, and if not, there are plently of other options..
]…CBT therapy… [“Stimulus control is basically a strategy to make it harder to pick by modifying your environment,” Zakhary says. So you might wear gloves, keep your skin covered, or apply skincare masks or lotions that feel soothing to the skin. There are also hundreds of “sensory substitutes” that you can use to keep your hands occupied during times when you’re most likely to pick, like playing with silly putty or a stress ball, knitting, or painting your nails. You can find a larger list of items and activities to keep your hands occupied through the TLC Foundation for Body-Focused Repetitive Behaviors.
In the second form of treatment, habit reversal training, “Individuals are basically taught to engage in a harmless motor behavior that’s incompatible with skin picking, so clenching your fists, for example
]… [It’s also worth noting that while there are no FDA-approved medications specifically for skin picking disorder, studies have also shown that medications like SSRIs and N-acetylcysteine, an over-the-counter antioxidant supplement, can be helpful additions to CBT.
]… [While confronting the mental and emotional aspects of your picking are the keys to truly conquering the disorder, there are some short-term aids you can incorporate to lessen the likelihood of picking.
]… [If your bathroom is a particular hotspot for your picking, you might choose to temporarily cover up the mirror or remove any magnifying mirrors in your home. Zakhary also suggests using Band-Aids (of the literal kind) to cover your lesions, or put them on the fingers you use to pick to prevent yourself from doing so. “I often recommend blister Band-Aids — they’re waterproof and will stay on for a couple of days,” Zakhary says.6 Expert Tips for Coping with Skin Picking Disorder | Apartment Therapy
I prefer the acne hydrocolloid patches. Smaller, less noticeable, helps if it’s a viral lesion (chickenpox, shingles, herpes) and can be very satisfying to remove and replace.
If the initial cause is resolved and it’s habitual, then habit modification is in order. It’s generally much easier to modify or replace the habit than it is to quit cold turkey.