Dermatillomania in Children: What Is It?
Although it’s common to scratch the skin from time to time, some children have the habit of doing it compulsively and this condition is known as dermatillomania. The problem with this condition is that it predisposes little ones to the appearance of irritating and infectious lesions and can even cause new ones to appear. In addition to scratching, children with this disorder may also pick at their skin out of impulse or habit and the consequences are the same. Interested in learning more about dermatillomania in children? Then be sure to keep reading.
What is dermatillomania?
Dermatillomania is recurrent scratching of the skin, leading to the appearance of skin lesions, distress, or functional impairment of the area involved. It’s also known as psychogenic or neurotic excoriation and skin picking disorder.
This condition can occur at any age but generally begins in adolescence, along with the onset of puberty. According to a publication by the International OCD Foundation, females are more likely to develop it than males.
Although it’s a long-documented condition, dermatillomania as a psychiatric illness has recently been added to the DSM-V obsessive-compulsive (OCD) and related disorders (OCRD) listing. However, not all children with OCD will develop skin picking disorder. That being said, however, the majority of those with dermatillomania will experience OCD.
What are the causes of dermatillomania in children?
Triggers for skin surface scratching can be multiple and vary among children, but the most representative are as follows:
- Stress
- Anger
- Anxiety
- Sedentary activities (watching TV and reading)
- Tiredness
- Boredom
Dermatillomania can manifest anywhere on the body and usually appears on a variety of exposed sites: The face, hands, fingers, legs, and arms.
Children with skin scratching disorder may manipulate bumps, scabs, pimples, or other skin lesions until they become inflamed or bleed. Sometimes these infants even let the scratched areas heal on their own only to injure them again. Once the habit takes hold, it is difficult to overcome.
Manifestations of dermatillomania in children
The inability to stop scratching despite repeated efforts to do so is a quite common aspect of this condition. It can even lead to social embarrassment, depression, anxiety, and avoidance of certain activities or situations where the skin lesions may be evident.
In general, the lesions may be inconspicuous, but also very visible. Because of this, some children try to cover them with make-up, clothing, or bandages.
The probable clinical sequelae of dermatillomania include the following:
- Infections
- Scars
- Injuries
- Severe physical disfigurement
The most common consequences of this condition are infections in the picked areas, and the severity of the condition we discuss today may depend on this.
The treatment of dermatillomania in children
While there are few studies regarding the management and treatment of this condition, one of the proposed therapeutic options is based on comprehensive psychiatric examination, medication, and cognitive behavioral therapy (CBT) or habit reversal therapy (HRT).
Although treatment may help to control symptoms and override undesirable behaviors, relapses may also be experienced. This is especially relevant after prolonged periods of behavioral interruption.
Non-pharmacological treatments
One of the non-pharmacological treatments is based on cognitive-behavioral interventions involving cognitive restructuring and psychoeducation. In addition, emphasis is placed on relapse prevention by improving self-efficacy.
In turn, in competitive response training, the child is taught how to replace skin scratching with an incompatible action. For example, fist clenching.
Drug treatments
Antidepressants may help to alleviate self-selective behaviors. In fact, several selective serotonin reuptake inhibitors (SSRIs) have been shown to improve scratching or picking behavior. Even lamotrigine, an antiepileptic agent, may have some benefit in the treatment of dermatillomania.
While there’s growing interest in the use of glutaminergic agents, there’s no scientific evidence to date to support their efficacy.
The condition can be complicated to treat, as the child does it to calm down and dispel another type of negative feeling.
Dermatillomania is more than a skin condition
In conclusion, dermatillomania is a psychological disorder that involves a strong, nervous, and frequent urge to scratch, pick, and pull at the skin.
Some of the reasons for not seeking help include social embarrassment and considering the condition to be a “bad habit” or untreatable. In fact, those seeking a therapeutic option often go to a dermatologist or general practitioner before consulting a psychologist or psychiatrist.
All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.
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- Snorrason I, Smári J, Olafsson RP. Emotion regulation in pathological skin picking: findings from a non-treatment seeking sample. J Behav Ther Exp Psychiatry. 2010 Sep;41(3):238-45. doi: 10.1016/j.jbtep.2010.01.009. Epub 2010 Feb 6. PMID: 20172501.
- Odlaug BL, Grant JE. Clinical characteristics and medical complications of pathologic skin picking. Gen Hosp Psychiatry. 2008 Jan-Feb;30(1):61-6. doi: 10.1016/j.genhosppsych.2007.07.009. PMID: 18164942.
- Schumer MC, Bartley CA, Bloch MH. Systematic Review of Pharmacological and Behavioral Treatments for Skin Picking Disorder. J Clin Psychopharmacol. 2016 Apr;36(2):147-52. doi: 10.1097/JCP.0000000000000462. PMID: 26872117; PMCID: PMC4930073.
- What is Skin Picking Disorder? [ Internet ] Disponible en: https://iocdf.org/about-ocd/related-disorders/skin-picking-disorder/