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A Dermatologist's Perspective

Many if not most skin diseases have an emotional or psychological component on some level. Sometimes stress makes the skin disease worse, sometimes the disease itself causes stress, and sometimes the psychological component actually can cause the skin disease. SISP can fall into any of these categories.

In dermatological terms, SISP can be classified into one of several diagnoses. Most people using this program will fall into the diagnosis of neurotic excoriations and excoriated acne. Several other diagnoses will be mentioned for completeness.

Neurotic excoriations refers to the uncontrollable urge to pick and dig at the skin. This urge may be unconscious or may be deliberate in the belief that it corrects some minor abnormality or surface irregularity of the skin. The picking creates more pronounced abnormalities so that a vicious cycle is started. It involves picking, digging or scraping at the skin persistently often until what is described as a “thread” can be pulled from the skin. Many old scars, which can be disfiguring, are visible near areas of active picking. These pickers usually are middle-aged adults and may be depressed, anxious or obsessive-compulsive. Women are more likely to be affected than men.

Excoriated acne occurs usually in girls or young women with very mild acne or even no acne at all. Often a magnifying mirror is used to search for minor acne lesions. These minute lesions are compulsively picked leaving excoriations and scars. This primarily occurs on the face but can be on the chest or back as well.

Prurigo nodularis consists of multiple intensely itchy nodules mostly on the legs and arms. The itching is so severe that lesions are scratched to the point of causing pea-sized crusted and firm warty nodules with brown pigmentation. Prurigo nodularis can occasionally be associated with internal diseases such as HIV infection or liver disease. Like these other skin diseases it can be exacerbated by psychological stress, but unlike the others it is not caused by stress. It occurs mainly in adults with men and women being affected equally. It can be a chronic disease lasting for years.

Factitious dermatitis refers to self-inflicted skin lesions made consciously to simulate a naturally occurring skin disease. The lesions are made with the fingernails or by some other mechanical means or by the application or injection of chemical irritants or caustics. The lesions have a geometric, bizarre appearance which does not suggest natural causes, although extensive searches are often done looking for an organic cause. These patients have an underlying psychopathology or are true malingerers.

Delusions of parasitosis involves a single fixed delusion of infestation of the skin with parasites. These patients are so convinced of their infestation that others believe them as well. They often bring pieces of skin debris and lint to their doctor’s appointments in a tissue or jar insisting that the parasite is contained in their specimen. The skin exam may be normal or may reveal minor excoriations. is intended for those people who suffer from neurotic excoriation and acne excoriation. Treatment of prurigo nodularis, factitious dermatitis and delusions of parasitosis is beyond the scope of this program and a medical doctor should be consulted if you believe you have any of these other disorders.

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What is self-injurious skin picking or "SISP"?
How many people have SISP?
What causes SISP?
Who picks their skin?
When is SISP a problem?
How do we treat SISP?
A Dermatologist's Perspective
Readiness for Change

About Skin Picking...

Individuals who suffer from CSP repetitively manipulate their skin, often in an attempt to remove small irregularities. In severe cases, significant tissue damage and visible disfigurement can result.

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