Skin Picking Disorder: A Canadian Retrospective Study of 83 Patients

Skin picking disorder (SPD) is classified as a primary psychodermatologic disorder, in which lesions are self-induced. It is frequently encountered by dermatologists, but the management is still a source of discomfort for the majority.

The first objective is to determine the characteristics of the SPD patients in our centre: the demographics, the psychiatric comorbidities, clinical and histopathological characteristics of SPD patients, treatments and follow-up. The second objective is to demonstrate the need for education in the dermatologic community.

We retrieved and described cases of SPD from January 2011 to December 2022. All inpatients were evaluated at the Centre Hospitalier Universitaire de Québec - Université Laval. Qualitative and quantitative data on SPD were collected.

The sample comprised 83 patients, with a mean age of 62 years, and a bimodal distribution. 63.8% were female and lesions were most frequently described as excoriations (27%). Physicians observed picking from multiple body sites, the most common being upper extremities. Only 11% of patients were biopsied. Psychiatric comorbidities were frequent, especially personality traits and disorders (19.2%), and substance-related and addictive disorders (16.8%). Wide variety of treatments were prescribed, including local and supportive care. Only 41% of the sample had medical follow-ups.

This large-scale retrospective assessment of patients diagnosed with SPD broadens the scope of a frequent disorder in dermatology, showing older age patients, unexpected psychiatric comorbidities and inadequate continuity of care. Results highlight the need for a collaborative approach and for frequent reassessments of these patients.