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Dermatillomania, also known as excoriation, is a mental health condition characterized by the repetitive picking at your skin (whether that be the scalp, face, cuticles, lips, etc.) to the point of tissue damage or distress.

And it’s more common than you might think. According to research on the prevalence of excoriation2, “2.1% of the population identified as having a current skin picking disorder, with 3.1% of the population reported lifetime skin picking disorder (i.e., current or past).” 

Skin picking is even more common for those struggling with other mental health conditions simultaneously. In that same prevalence study:

• 63.4% of those with dermatillomania also had anxiety. 
• 53.1% had depression. 
• 27.7% had post-traumatic stress disorder (PTSD). 
• 26.3% had obsessive-compulsive disorder (OCD). 

As stated above, mental health triggers are a significant reason that people pick at the skin and the scalp. “Compulsive picking is often preceded or accompanied by a high level of anxiety or stress that may trigger skin-picking episodes,” Pirok says.

“Skin picking can release endorphins and dopamine in some, causing a temporary feeling of pleasure and satisfaction,” Pirok says. “For others, skin picking is a way to self-soothe, tuning out the world and focusing on just one thing,” he continues.

For those with OCD, picking acts as a compulsion to neutralize the obsession about the skin, he says.

“For some, the act of skin picking provides a feeling of relief or pleasure,” he continues. So you may rely on picking the scalp as a way to feel better during a time of high stress, or it may become something that gives your brain a feeling of pleasure.

It’s important to note that “Skin-picking episodes can be a conscious response to anxiety or may be done as an unconscious habit,” Pirok says. To repeat: Skin picking is not always intentional—you can fully pick at your skin as an unconscious habit.

Skin picking can also be a trauma response in children and adults. “We have seen that trauma in childhood, such as physical or sexual abuse, loss of a loved one, a parents’ divorce, etc., can trigger some children to begin picking their skin,” Pirok notes.

“And for adults already diagnosed with the disorder [dermatillomania], physical or psychological trauma can certainly cause picking to amplify,” he continues.

Scalp irritation or discomfort can be a physical trigger for scalp picking. If you are wearing protective styles, such as tight braids or ponytails, you may be more inclined to reach for the scalp in the first place.

Plus, if the style causes inflammation, then you may want to pick at the inflamed skin either to soothe or itch the area. Especially if you wear tight styles often, this can quickly become a habit.

While dermatillomania on the scalp can eventually result in hair loss, it is not the same as compulsive hair-pulling, formally called trichotillomania3. That being said, trichotillomania (which can happen on the head, lashes, brows, etc.) and dermatillomania are both compulsive disorders often triggered by mental health conditions like stress and anxiety.

Also, according to the prevalence study, 12.7% of people with dermatillomania also have trichotillomania—so if you’re pulling your hair and picking your scalp or skin, you’re not alone.

When you feel the imperfect skin on your scalp (or anywhere else) that becomes an obsession—then, picking follows as the compulsion, Pirok says. “A way to disconnect the obsession from the compulsion is to develop a replacement behavior, something you do instead of picking,” he says. “Which thereby increases the time from the obsession to the compulsion.” 

You can replace picking with the application of a scalp-soothing product, like the Carter+Jane ScalpFix+ or PickFix for the skin—both of which are formulated to help with scalp and skin picking while simultaneously nourishing the skin.

Or, you can opt for gentle scalp massage. “I always recommend replacing a more damaging habit, such as scalp picking, with a more positive practice such as a scalp massage with a scalp gua sha,” certified trichologist, celebrity stylist, and founder of scalp-first hair care brand Act+Acre Helen Reavey tells mbg.

“Not only will they promote relaxation, but more importantly, they will positively impact the scalp, reversing the potential for additional irritation and damage,” she continues.

“This replacement or delay of the compulsion is in essence using a ‘harm reduction model,'” Pirok says. “Replacing picking with an activity you do with your hands is typically very structured at first then becomes automatic,” he continues. This is the first step to easing scalp picking—more tips to follow.

Scalp and skin picking are more often related to mental health and less often to do with beauty. So the first step to tending to your mental health is to work on lowering levels of anxiety.

When you feel yourself start to pick, try to replace it with one of these soothing strategies instead.

Here, a few general relaxing techniques to explore:

Breathwork is an active form of meditation that can help you disconnect from your mind and enter a relaxed state. The best part? You can do this anywhere, anytime. So if you feel yourself starting to pick in a social setting, try to focus on your breath.

Breathwork comes in many different techniques—here are a few to explore and their benefits.

Research studies have found that exercise may help alleviate depression and anxiety overall4—which in turn, will help ease scalp picking at the source. Not to mention, exercising (even if it’s just for 20 minutes a day) will help fill the gap in your schedule.

If you find yourself picking during moments of leisure or boredom, then exercising during those times—whether it be yoga, walking, running, or another activity—may help distract you from picking and boost your brain health as well.

Meditation has been around forever, but in recent years researchers have put it to the test for anxiety—with exciting and positive results. In this review5, researchers deemed mindfulness-based therapy as “a promising intervention for treating anxiety and mood problems in clinical populations.”

Of course, seeking professional help is most important when it comes to conditions like anxiety, but meditation is one practice to keep in your back pocket.

Finding a form of meditation you truly enjoy is the first step to creating a consistent and beneficial practice, so here are the 12 basic kinds of meditation to get you started.

If you have damaged skin on the scalp, Heavey recommends avoiding alcohol and fragrance. In addition, exfoliating ingredients like salicylic acid and tea tree may sting the broken skin.

Look for organic, hypoallergenic hair products. When you shampoo, avoid scratching the scalp with your nails, and most definitely do not use any kind of scalp scrubs or chemical exfoliating treatments while your skin is healing.

Just as you wouldn’t put irritating ingredients on damaged facial skin, the same goes for the scalp. Instead, use hypoallergenic and clean hair care products and scalp treatments, like the Act+Acre soothing serum.  

“Our Stem Cell Scalp Serum is actually full of wound-healing ingredients including aloe vera, glycerin, and apple stem cells,” Reavey explains. “They work to hydrate the scalp and reduce irritation, helping to move the wound-healing process along,” she continues.

Avoid other damaging practices like extra-hot showers, violently brushing through your hair, and blow-drying the roots if you can help it. Let the skin on your scalp fully heal before going for any kind of exfoliation or strenuous hairstyles.

If you pick your scalp every once in a while due to product buildup or tight hairstyles, it may not technically be dermatillomania. However, if this has become a habit or you see physical damage to the scalp (as in scratches, broken skin, etc.), then you should see a mental health professional if you can.

“Cognitive Behavioral Therapy (CBT), a type of talk therapy, in addition to Exposure Response Prevention (ERP), is currently the most effective therapeutic approach for excoriation disorder,” Pirok says.

And if you’re tending to your mental health and working to limit picking, visiting a dermatologist or trichologist can be beneficial for your scalp health, too. These professionals can help you pick and choose safe and effective topical products to encourage healing and minimize irritation.

And remember, skin and scalp picking are common, especially if you are already struggling with depression or anxiety. Know that you are not alone and there are plenty of professionals out there to help you through the process.