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Skin Picking and the Role of Stress

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Stress and Skin Disorders

Abstract

Skin picking (SP) in response to a stressor that causes an itch or other dysesthesia is usually initially adaptive, but when scratching or skin picking becomes chronic it might lead to skin ulcers or trigger the ‘itch-scratch cycle’. SP is a body-focused repetitive behavior that becomes a clinically significant symptom when recurrent skin picking results in skin lesions and causes significant impairment or distress in social, occupational or other important areas of functioning. In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), clinically significant skin picking is classified as Excoriation or Skin Picking Disorder. The skin serves as both (i) an immune organ and metabolically active interface between the individual and the outside world during sleep and wakefulness, (ii) an organ of communication throughout the life span- at neurobiological, psychological and social levels. Due to its strategic location, the skin plays a critical role in preserving homeostasis, as it is regularly exposed to potentially dysregulating stimuli, both physical and psychosocial. The skin has the capacity to mount an allostatic response by recognizing, discriminating, and integrating various physiological and psychosocial stimuli in a complex environment. Picking of the skin can be a feature of this response. Clinical assessment of the role of stress in SP involves the consideration of neurobiological (e.g., sleep and circadian rhythm disruption), psychiatric (e.g. comorbid obsessive-compulsive disorder, body dysmorphic disorder and dissociative disorders), psychosocial (e.g., stress from daily hassles, major life events and traumatic events) and dermatologic factors (e.g., presence of stress-mediated pruritic dermatoses such as psoriasis and atopic dermatitis), as stress can have varying effects in any particular patient.

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Authors and Affiliations

  1. Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, 585 Springbank Drive, Suite 101, London, ON, Canada, N6J 1H3

    Madhulika A. Gupta MD, FRCPC

  2. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Aditya K. Gupta MD, PhD, FRCPC

  3. Mediprobe Research, London, ON, Canada

    Aditya K. Gupta MD, PhD, FRCPC

Authors
  1. Madhulika A. Gupta MD, FRCPC
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  2. Aditya K. Gupta MD, PhD, FRCPC
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Corresponding author

Correspondence to Madhulika A. Gupta MD, FRCPC .

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Editors and Affiliations

  1. Centro Studi per la Ricerca Multidisciplinare e Rigenerativa Department of Dermatology, Università degli Studi Guglielmo Marconi, Rome, Italy

    Katlein França

  2. Department of Psychiatry, Central Michigan University College of Medicine, Saginaw, Michigan, USA

    Mohammad Jafferany

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Gupta, M.A., Gupta, A.K. (2017). Skin Picking and the Role of Stress. In: França, K., Jafferany, M. (eds) Stress and Skin Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-46352-0_8

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  • DOI: https://doi.org/10.1007/978-3-319-46352-0_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-46351-3

  • Online ISBN: 978-3-319-46352-0

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