Picking Apart the Picker: A Clinician's Guide for Management of the Patient Presenting With Excoriations

Management of patients who "pick" at their skin is often difficult. Etiologies and maintaining factors can be unclear. Significant psychiatric overlay is often present, and the clinician is left with an overwhelming differential diagnosis and a poorly focused treatment plan that can result in suboptimal clinical outcomes. The purpose of this paper is to provide a conceptual framework for the evaluation and treatment of patients presenting with excoriations. Ten diagnostic categories are examined, and specific suggestions for treatment are offered.