Skin Picking Disorder and Other Picking or Pulling Habits: What Dermatologists Want You to Know

Maybe it’s biting a fingernail, picking at a blemish, or simply tugging on a strand of hair. These behaviors may seem like simple bad habits, but if they become frequent, hard to control, or they start leaving visible marks, they can feel frustrating and even embarrassing. These kinds of behaviors are known as body-focused repetitive behaviors (BFRBs) that can lead to real changes in your skin, hair, and nails.

If your skin, hair, or nails are changing or causing you distress because of picking, pulling, or biting, you’re not alone. In fact, around 24% of people are estimated to experience some form of this behavior during their lifetime, including nail biting (11.4%), skin picking (8.2%), and lip/cheek biting (7.9%). Talking with a doctor about compulsive skin picking can be an important first step toward relief.

What are body-focused repetitive behaviors (BFRBs)?

BFRB is simply the technical term for a group of conditions in which a person repeatedly picks, pulls, bites, or otherwise manipulates their skin, hair, or nails in ways that can cause physical damage. 

Many people engage in these behaviors on occasion, like picking at a scab or biting a thumbnail during a stressful moment. But when “occasionally” becomes “frequently,” and when a skin picking disorder leads to visible changes, it usually falls under the BFRB label. The most common BFRBs include: 

• Excoriation: Picking at the skin that leads to sores, scabs, or wounds

• Trichotillomania: Repeated pulling of hair from the scalp, brows, lashes, or other areas.

• Onychophagia and cuticle picking: Chronic nail biting or picking that damages the nails and surrounding skin

Clinicians generally agree that these behaviors can be driven by anxiety or emotional tension, sensory urges or discomfort, or attempts to “fix” perceived imperfections. Many times, these are simply automatic behaviors that happen without your full awareness. The behavior can even provide a momentary sense of relief or satisfaction even though it may lead to pain or skin damage afterward.

Studies show a significant overlap between dermatology and behavioral health in conditions like excoriation disorder and trichotillomania. In fact, people with BFRBs are more likely to also have obsessive compulsive disorder (OCD). According to the International OCD Foundation, the two conditions actually share some genetic risk factors. This makes it even more important to see an experienced dermatologist trained to recognize when a BFRB might be an indicator of something else.

What dermatologists commonly see

Dermatologists are trained to recognize the patterns of BFRBs and understand the difference between damage caused by picking or biting and changes caused by an underlying medical condition. What they see in the exam room can vary widely, but several findings are especially common:

Skin picking

• Sores that don’t heal or that reopen repeatedly

• Scabs or open wounds in various stages of healing

• Scarring or discoloration, including dark spots or lighter patches

• Secondary infections, such as redness, swelling, or pus caused by bacteria entering damaged skin

Hair pulling

• Patchy hair loss with irregular borders

• Broken hairs of different lengths

• Tender or inflamed areas where pulling is frequent

• Sparse brows or lashes, sometimes accompanied by redness or irritation

Nail biting and cuticle picking

• Damaged or inflamed cuticles

• Nail deformities, thinning, ridging

• Bleeding or painful hangnails

• Bacterial or fungal infections around the nail folds

How a dermatologist can help

When picking, pulling, or biting starts to leave marks, many people feel embarrassed and worry a dermatologist will judge the behavior as a simple bad habit. In reality, BFRBs are recognized conditions with emotional and biological components, not failures of willpower or discipline. A big part of a dermatologist’s care is removing shame so people can get the help they deserve.

The first priority is treating the physical effects of the behavior: the sores, irritation, hair loss, damaged cuticles, and infections. Dermatologists can provide wound care, manage inflammation, treat infections, support hair regrowth (when possible), and address scarring or discoloration.

Dermatologists are also trained to distinguish damage from BFRBs from conditions like eczema, psoriasis, alopecia areata, or fungal infections. Sometimes an underlying dermatologic condition is contributing to the urge or making the skin more vulnerable, so ruling out these causes is a key part of the exam.

If your doctor suspects a BFRB, they can recognize when additional support may be helpful. For some people, combining dermatologic treatment with behavioral approaches, such as cognitive‑behavioral therapy or habit‑reversal training, leads to better healing and fewer recurrences.

When to see your dermatologist 

Everyone picks, pulls, or bites from time to time. But when the physical effects of these actions start to interfere with your comfort, healing, or confidence, it’s time to seek help, especially if you notice the following:

• Pain, bleeding, or sores that don’t heal

• Visible hair loss or bald patches 

• Recurrent infections

• Scarring or discoloration 

• Changes in nail shape or strength

• Significant distress or difficulty controlling the behavior 

• Impact on daily life

Seeking care doesn’t mean the behavior is “severe” or that you’ve done something wrong. It simply means your skin, hair, or nails are being affected, and a dermatologist can help you heal, understand what’s going on, and connect you with additional resources if needed.

If you’re worried your “bad habit” may actually be something more serious, contact a Forefront dermatologist today and get the help you need.