https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2500041

Study 1: N-Acetylcysteine in the Treatment of Excoriation Disorder

This study showed that N-Acetylcysteine could serve as a possible treatment

53 participants who completed the study, 15 of the 32 participants (47%) receiving N-acetylcysteine were much or very much improved compared with 4 of the 21 participants (19%) receiving placebo (P = .03). There were no significant differences between the active and placebo arms in terms of psychosocial functioning.

The researchers used NE-YBOCS to quantify their results. The Yale-Brown Obsessive Compulsive Scale (NE-YBOCS); total scores range from 0 to 40, with higher scores reflective of greater symptom severity. 

https://psychiatryonline.org/doi/10.1176/appi.ajp.20220737

https://pubmed.ncbi.nlm.nih.gov/36856701

Study 2: Double-Blind Placebo-Controlled Study of Memantine in Trichotillomania and Skin-Picking Disorder

This article suggests that Memantine is a treatment that could help with skin-picking

Compared with placebo, memantine treatment was associated with significant improvements in scores on the NIMH scale, Sheehan Disability Scale, and Clinical Global Impressions severity scale in terms of treatment-by-time interactions. At study endpoint, 60.5% of participants in the memantine group were “much or very much improved,” compared with 8.3% in the placebo group (number needed to treat=1.9). Adverse events did not differ significantly between the treatment arms.

The NIMH scale is a 6-item scale (total score ranges from 0 to 20) comprising questions assessing pulling/picking frequency (past week and yesterday), urge intensity, subjective distress, and interference in daily activities. In the case of participants with both trichotillomania and skin-picking disorder, the questions pertain to both behaviors.

https://pmc.ncbi.nlm.nih.gov/articles/pmid/37466986

Study 3: Self-Help Habit Replacement in Individuals With Body-Focused Repetitive Behaviors

This article uses habit replacement to treat somatic sequelae (skin picking (68.3%), trichotillomania (28.4%), nail biting (36.6%), and lip-cheek biting (26.1%)). 

Participants were recruited via social media. In brief, participants in the habit replacement condition were encouraged to perform simple, gentle circling movements; this was explained in a manual and video demonstration (see eAppendix in Supplement 1 with instructions and link to the video). 

The experimental group significantly improved on the primary outcome (GBS-45)

 [The Generic Body-Focused Repetitive Behavior Scale-45 (GBS-45) is a comprehensive self-report questionnaire designed to assess the severity and impact of various body-focused repetitive behaviors (BFRBs), including skin picking, nail biting, and hair pulling. It consists of 45 items that evaluate different dimensions of BFRBs, such as frequency, intensity, and associated distress.]

Like most investigations on BFRBs, study limitations include:

• lack of external assessment and verified diagnoses. 

• Despite some evidence that self-help interventions can provide lasting effects, this has yet to be shown for habit replacement. 
• majority of participants were White women 
• less than half of the experimental group followed the protocol

https://pmc.ncbi.nlm.nih.gov/articles/PMC1702340

Study 4: Reducing Skin Picking via Competing Activities

This study follows a 9-year old boy, Jason, with ADHD (who takes adderall to help with his ADHD) who has skin-picking disorder. Researchers found that Jason picked his skin when his hands were idle, specifically at times in class when he was supposed to read. The researchers gave Jason balls of varying textures to play with while he was reading to prevent skin picking. The percentage of the time he was picking his skin over a 30-day period with only medication, medication + intervention, and only intervention is summarized below. The intervention + medication proved to be the best. Intervention was found to show improvement.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8001957

Study 5: Dermatillomania: Strategies for Developing Protective Biomaterials/Cloth

This research articles details various approaches to curbing the habit and their efficacy (pharmacological, behavioral, etc.). Then, they propose an approach that would leverage biomaterials like synthetic skin to lessen the destruction of the disorder.

https://www.mdpi.com/2624-8611/5/3/43

Study 6: Bridging the Gap between Dermatology and Psychiatry: Prevalence and Treatment of Excoriation Disorders Secondary to Neuropsychiatric Medications 

Some instances of skin-picking disorder can be caused by use of antipsychotics or SSRIs. Solution: offending medication is no longer taken or another medication is used to treat skin-picking on top of the other medication.

https://www.jmir.org/2019/9/e15011

Study 7: An Internet-Based Self-Help Intervention for Skin Picking (SaveMySkin): Pilot Randomized Controlled Trial

Participants used skin-picking preventative website SaveMySkin to find community support and receive cognitive behavioral therapy to quit skin-picking. Unfortunately, this intervention is only in German 🙁 https://www.savemyskin.de/welcome and they are no longer taking new participants. Additionally, it proved to be quite successful.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10508252

Study 8: “Reduction of Pathological Skin-Picking Via Expressive Writing”

132 female participants completed six writing sessions over two weeks, focusing on emotional experiences with personal relevance.

Expressive writing, exercises where people free-write about their thoughts and feelings, produced positive short-term effects, including a reduced urge to pick the skin and increased feelings of relief immediately after writing sessions. Mid-term effects included a reduction in focused skin-picking behaviors, as reported by participants. The participants spent 10 minutes a day on free-writing. After their writing sessions, they felt a reduced urge to skin pick. Those who were asked to describe a painting, directly indicated that they no longer wanted to manipulate their skin.

https://academic.oup.com/ced/article/50/2/299/7746452

Study 9: A systematic review of nonpharmacological treatment options for skin picking disorder

Cognitive-behavioral therapy (CBT), habit reversal training (HRT), and acceptance and commitment therapy (ACT) resulted in significant reductions in skin-picking behaviors across multiple studies.

https://arxiv.org/abs/2106.10970

Study 10: Anticipatory Detection of Compulsive Body-focused 

Findings revealed that skin-picking episodes were often preceded by negative emotional states such as anxiety or boredom. The behavior frequently occurred in private settings and was associated with temporary relief, followed by feelings of guilt or shame. Wearable technology offers a promising avenue for real-time monitoring and intervention in skin-picking disorder, providing users with immediate feedback and support to manage compulsive behaviors (reminds me of the BeWell app discussed in CS347). In a follow-up qualitative survey, the researchers found that not only the timing of detection matters but also models need to be context-aware, when designing just-in-time interventions to prevent BFRBs. 

https://pubmed.ncbi.nlm.nih.gov/37731870/

Study 11: Short-term intervention complemented by wearable technology improves Trichotillomania – A naturalistic single-case report

Researchers combined BFRB Awareness Training online modules with a wearable device that vibrates when it notices that the participant is about to engage in BFRB behavior. The findings suggest that this approach reduces episodes of BFRB behavior! The study was conducted over 214 days. Issues with the approach is that it was distracting since the behavior is compulsive. While studying for exams or working, participants claimed that they were distracted by the vibrations when attempting to engage in hair pulling or skin picking.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9063575

Study 12: Trichotillomania and Skin-Picking Disorder: An Update

Trichotillomania is typically misdiagnosed as OCD and anxiety disorder (which is typically comorbid). Habit reversal therapy has been proven to treat these disorders as well as pharmacological approaches like N-acetylcysteine which was explored in our other research papers.

https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.732717/full

Study 13: Pathological Skin Picking: Phenomenology and Associations With Emotions, Self-Esteem, Body Image, and Subjective Physical Well-Being

Skin-picking usually occurs at multiple sites on the body, and is predated by negative emotions (tension, anxiousness, depression, and boredom). Feelings of loss of control and other life-altering events can foster the development of this disorder or exacerbate it. Low self-esteem and body-issues are also strong indicators of who will develop the disorder. This disorder is frequently comorbid with anxiety, eating disorders, clinical depression, and other disorders regarding self-esteem and body image.