In more severe cases the habit is uncontrollable and may turn into an urge to dig deep into the skin. Skin picking can also occur secondary to delusions of parasitosis, but these patients have a psychotic character and therefore differ from those with typical presentations of neurotic excoriations. We have seen about forty patients over the past few years suffering from neurotic excoriations, and many engage in picking for several hours per day.
Patients frequently require dermatological interventions for their skin wounds and infections.
Some of our patients reported medical hospitalizations and surgical revisions for wounds that did not heal because they were not able to stop picking. Recently a patient was described who picked a hole through the skin and neck muscles and nearly lacerated her carotid artery. The excoriations are produced with fingernails or small instruments such as tweezers or pins. Visual inspection and touching of the skin often precedes picking. Patients describe an uncontrollable urge to pick blemishes, and they report a temporary feeling of relief when blemishes are removed.