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Nonpharmacological Treatment Options for Patients With Skin Picking Disorder
TAKE-HOME MESSAGE
- This review assessed data from skin picking disorder (SPD) studies published between 2017 and 2023 to provide an updated guide on nonpharmacological treatment options for SPD. Data from 11 studies were reviewed. The results showed that cognitive behavioral therapy, habit reversal therapy, acceptance and commitment therapy–enhanced group behavioral therapy, online self-help modules, and expressive writing were the best options for the treatment of patients with SPD.
- Nonpharmacological treatments are effective in treating SPD and can be tailored to meet patients' specific needs.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
While Skin Picking Disorder (SPD) is a well-described neuropsychiatric disorder that causes severe stress and impairment, there is no clear protocol for treating patients and a relatively small body of literature evaluating treatment approaches.
OBJECTIVE
This review aims to summarize and compare recent publications and provide an up-to-date guide of current non-pharmacological treatments for SPD.
METHODS
A literature review was conducted on all non-pharmacological SPD treatment studies published between 2017-2023 using PubMed, CINAHL Plus with Full text (EBSCO), and Scopus. Search terms included skin picking, excoriation, psychiatry, treatment, and psychodermatology. Studies including SPD within other body-focused repetitive behaviors (BFRBs), studies using pharmacological agents, and studies not available in English were excluded. A minimum of 2 authors screened each abstract while blinded to minimize bias to assess for inclusion.
RESULTS
11 studies (2068 participants) were included, with a variety of study designs including feasibility, randomized control trial, longitudinal cohort, multiple baseline experimental, naturalistic trial, and controlled single case design with multiple baseline studies. The treatments include cognitive behavioral therapy (CBT), Acceptance and Commitment Therapy (ACT), ACT-Enhanced Group Behavioral Therapy (AE-GBT), ACT-Informed Exposure Therapy, group therapy, psychotherapy, Repetitive Transcranial Magnetic Stimulation (rTMS), online self-help modules, and Expressive Writing (EW). Studies implementing CBT, Habit Reversal Therapy (HRT), AE-GBT, online self-help modules, and EW demonstrated the best results in treating SPD.
CONCLUSION
Several studies achieved significant outcomes for SPD participants, confirming the usefulness of non-pharmacological treatment in SPD. Based on our results, CBT, AE-GBT, online self-help modules, and EW appear to be the most effective in treating SPD. Additionally, most of these treatment modalities can be tailored to meet patient-specific needs. Some limitations of the studies include small sample sizes, lack of control groups/randomization, limited long-term follow-up data, and lack of gender variability.
Additional Info
Disclosure statements are available on the authors' profiles:
A Systematic Review of Non-Pharmacological Treatment Options for Skin Picking Disorder (SPD)
Clin Exp Dermatol 2024 Aug 31;[EPub Ahead of Print], H Loftus, C Cassidy, L Mun, M JafferanyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Skin picking disorder (SPD) is a common problem in dermatology practice. The condition is associated with significant morbidity and comorbidities. Patients with SPD may not optimally respond to pharmacologic therapy; in such cases, psychotherapies should be considered. This comprehensive systematic review by Loftus et al highlights the importance of employing psychotherapies in managing patients with SPD. Of the various psychotherapies included in this review, cognitive behavioral therapy, habit reversal therapy, acceptance and commitment therapy–enhanced group behavioral therapy, online self-help modules, and expressive writing demonstrated the best results in treating patients with SPD.
The authors acknowledge the limitations in their review, including the small sample sizes in several studies, limited use of waitlist control groups and randomization, and limited long-term follow-up data. Previous studies not included in this review (databases were searched for publications from 2017 to 2023) have indicated that psychotherapy results may not be sustained in a proportion of patients. It would be advantageous if the review stratified the severity of SPD in the studies, as gains may not be fully sustained in many patients with severe SPD. Such challenging cases may benefit from combining psychotherapies and/or adding a pharmacologic treatment. The review ultimately emphasizes the need for more comprehensive studies and raises awareness regarding various psychotherapies in the dermatologic community to improve the holistic management of patients with SPD.