A systematic review of nonpharmacological treatment options for skin picking disorder

Skin picking disorder (SPD) is a well-described neuropsychiatric disorder that causes severe stress and impairment. However, there is no clear protocol for treating patients, and only a relatively small body of literature evaluating treatment approaches. This review aims to summarize and compare recent publications and provide an up-to-date guide of current nonpharmacological treatments for SPD. A literature review was conducted on all nonpharmacological SPD treatment studies published between 2017 and 2023 using PubMed, CINAHL Plus with Full Text (EBSCO) and Scopus. Search terms included 'skin picking', 'excoriation', 'psychiatry', 'treatment' and 'psychodermatology'. Studies including SPD within other body-focused repetitive behaviours, studies using pharmacological agents, and studies not available in English were excluded. A minimum of two authors screened each abstract to assess for inclusion while being blinded to minimize bias. Eleven studies (2068 participants) were included, with a variety of study designs including feasibility, randomized controlled trial, longitudinal cohort, multiple-baseline experimental, naturalistic trial, and controlled single-case design with multiple-baseline studies. The treatments include cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), ACT-enhanced group behavioural therapy (AE-GBT), ACT-informed exposure therapy, group therapy, psychotherapy, repetitive transcranial magnetic stimulation, online self-help modules, and expressive writing. Studies implementing CBT, habit reversal therapy, AE-GBT, online self-help modules, and expressive writing demonstrated the best results in treating SPD. Several studies achieved significant outcomes for participants with SPD, confirming the usefulness of nonpharmacological treatment in SPD. Based on our results, CBT, AE-GBT, online self-help modules and expressive writing appear to be the most effective in treating SPD. Additionally, most of these treatment modalities can be tailored to meet patient-specific needs. Some limitations of the studies include small sample sizes, lack of control groups and randomization, limited long-term follow-up data and lack of gender variability.