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. Stressful circumstances usually increase picking behaviors.
Some patients describe being in an almost trancelike state while picking at lesions.
Patients often report that they try to resist the urge, but they usually find it difficult to control. A few of the patients we saw in our clinic looked somewhat disfigured because of scarring that resulted from skin picking, and most of them had mild acne. Patients were generally very embarrassed about their behavior and camouflaged the resulting lesions with make-up or clothing. Skin picking typically does not occur in the presence of other people, but interestingly, occasional patients reported picking at other people9s skin. However, the lack of modern diagnostic criteria limits the value of these studies.