SSRIs Are Most Effective in Treatment of Skin-Picking Disorder
Researchers conduct a scoping review to update and determine what the best available options are for treating patients with skin-picking disorder.
Selective serotonin reuptake inhibitors (SSRIs) demonstrated the most promising results in treating the severity and frequency of skin-picking disorder when compared with other pharmacologic therapies, according to a study published in the Journal of the Academy of Consultation-Liaison Psychiatry.1
“Skin-picking disorder (SPD), also known as excoriation disorder or pathological skin picking (PSP), is a common psychocutaneous condition characterized by the repeated urge to pick compulsively at the skin and frequent unsuccessful attempts to decrease the picking, resulting in visible lesions on the skin,” wrote the authors of the study. “Diagnostic criteria also include significant impairment in daily functioning and/or substantial distress caused by the skin-picking.”
According to a study published in JAAD Reviews, SPD impacts around 3.5% of the US population and is more common among women.2 When it comes to pharmacological treatment options, SSRIs, opioid blockers, lamotrigine (commonly used to treat seizures and bipolar disorder3), and n-acetylcysteine (NAC) are all viable therapies used to treat SPD.4
SPD is also known as excoriation disorder or pathological skin picking (PSP) and is a common psychocutaneous condition. | image credit: LoloStock / stock.adobe.com
Despite these approved methods of treating SPD, habit-reversal therapy (HRT) and other nonpharmacologic options have become the main methods of treating the disease due to a lack of evidence regarding pharmacotherapy options.
READ MORE: Children with Skin Diseases at Higher Risk of Sleep Disorders
“The most recent systematic review on pharmacologic treatment in SPD, across all age groups, was in 2017,” wrote the authors.1 “This scoping review provides a detailed compilation of updated pharmacologic treatments for SPD, based on evidence from recent studies and/or clinical trials.”
As part of the researchers’ review, they explored PubMed articles that included the terms “treatment” and “skin picking” or “excoriation” in November 2024. They only included articles that were published in the previous 20 years, were in English, and were classified as clinical trials, case reports, or cohort studies. Furthermore, researchers only included articles that solely focused on pharmacologic treatment for SPD among individuals under 18 years old.
A total of 192 articles were extracted during the review, but only 13 studies were included in the final analysis. Of these articles, 7 were case reports and 6 were randomized controlled trials. Along with the aforementioned treatment options for SPD, the pharmacologic therapies included in the review were SSRIs, glutamatergic drugs (N-acetyl cysteine, memantine), antiepileptics (lamotrigine, topiramate), lithium, antipsychotics (olanzapine, aripiprazole), opioid antagonists (naltrexone), and mirtazapine.
Of the 7 pharmacologic treatment options for treating SPD that were explored in the study, one stood out amongst the rest.
“Overall, the efficacy of SSRIs has been well-documented, and they seem to be of particular benefit in improving symptoms related to the obsessive-compulsive nature of SPD,” continued the authors.1 When participants in the Arbabi et al study used a specific SSRI (citalopram), their PSP was significantly reduced.
However, despite SSRIs being prominent medications that have shown significant evidence in treating SPD, they are not the only pharmacologic option for relieving patients’ symptoms.
“Although HRT remains the first-line treatment, pharmacologic agents are increasingly necessary to effectively control skin-picking symptoms. Among these medications, SSRIs, glutamatergic drugs like NAC, and augmentation of SSRIs with antipsychotics show the most potential in treating behaviors associated with SPD.”
With notable therapies in both the pharmacologic and nonpharmacologic spaces for treating SPD, patients suffering from the disease now have multiple methods of managing its symptoms. However, at such early stages in the public’s understanding of SPD, more research is necessary to advance the knowledge of SPD and understand how to treat it going forward.
“SPD is a complex psychocutaneous disease that requires prompt therapeutic intervention as it can have profound psychosocial repercussions,” concluded authors of the study.1 “Moving forward, more robust, rigorous controlled trials with larger sample sizes are necessary to establish a well-documented, evidence-based treatment framework for SPD that optimizes clinical outcomes.”
READ MORE: Dermatology Resource Center
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