Drugs That Cause Skin Picking: Treatment & Prevention – Verywell Health

Michelle Pugle is an expert health writer with nearly a decade of experience contributing accurate and accessible health information to authority publications.
Leah Ansell, MD, is a board-certified dermatologist and an assistant professor of dermatology at Columbia University.
Skin picking is when a person repeatedly picks at their skin, causing damage to the tissue. Wounding, lesions, infection, and scarring can all occur as a result of skin picking. A person may pick their skin with their fingernails, or use tools like tweezers. They may or may not be aware of their behavior.
This article identifies which drugs cause skin picking, what complications can arise from skin picking due to drug use, what treatments are available, and how to prevent skin picking.
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Several similarities between skin picking and substance use disorders (addictions) have been demonstrated, including:
Misuse of certain drugs can result in skin picking as well. This is because some drugs, including both recreational (or illicit) drugs and prescription drugs, cause skin picking as a side effect. 

Skin picking as a symptom of drug use is different from skin picking due to mental disorders. 
Skin picking disorder is known as excoriation or dermatillomania. Excoriation is associated with impulsive control disorder, obsessive-compulsive disorder, or body-focused repetitive behaviors. Excoriation is a mental disorder and is not caused by drug use, but some medications may help reduce the urge to pick the skin and cognitive behavioral therapy can help you learn how to stop skin-picking.
Ongoing methamphetamine use, particularly methamphetamine-induced psychosis, can cause a neurological symptom in which the user feels the sensation of bugs crawling on or under the skin (also known as “meth mites). This sensation is clinically referred to as “formication.”
Someone experiencing formication engages in chronic skin picking to the point of causing skin ulcers that often scar. A lack of hygiene paired with compromised immunity from methamphetamine use puts the person at increased risk of skin infection.
Cocaine use, particularly cocaine-induced psychosis, can also cause the sensation of bugs crawling on or under the skin (also known as "coke bugs" or formication).
Formication due to cocaine use and other drugs is clinically explained as a delusion of parasitosis, the false belief that one is infected with a parasite or other non-visible organisms.
Heroin use releases histamines in the body which leads to feelings of extreme itchiness. A person using heroin may scratch excessively. Scratching doesn't stop the release of histamines, so a person will scratch themselves until and after sores or scabs form.
Some prescription medications can cause skin picking as a side effect. A common example is stimulant medications used for attention deficit hyperactivity disorder (ADHD) treatment. Amphetamine prescription medications, which are different than methamphetamines, also work on the dopamine pathway and can cause skin picking.
Examples of amphetamine stimulant medications for ADHD include:
If prescription medications are causing skin picking, it's important to tell your healthcare provider. They can safely adjust your dose or work with you to find a different type of medication that treats ADHD symptoms without causing skin picking.
Some tips if you or a loved one are struggling with drug addiction include:

Skin picking is not without consequence. There are mental, social, and physical effects associated with chronic skin picking.
Psychological and social effects of skin picking include:
Physical effects of skin picking include:
If skin picking is due to drug use and misuse, seeing your healthcare provider is necessary to find the right support and treatment.

If skin picking is causing distress, feelings of shame and embarrassment, or you don't know why you've started and can't stop skin picking, those are also signs it's time to talk to your healthcare provider. They can offer specific treatment options.
Treatment for skin picking will depend upon the cause. Treatment for physical effects of skin picking may including directly treating infection with antibiotics. Extensive skin damage may require skin grafting to repair damage. If skin picking is caused by misuse of drugs, then treatment will focus upon stopping the drug use as well as any other treatment options your healthcare provider sees fit. Treatment options for skin picking include the following.
Some prescription medications like antidepressants and anticonvulsants may help resolve symptoms leading to or causing skin picking.
These medications work in different ways to adjust brain chemicals associated with skin picking behavior. You and your healthcare provider can discuss which, if any, may be appropriate in your situation depending on the cause of skin picking.
Several forms of therapy may be used in the treatment of skin picking. Different therapies for skin picking include:

It’s not exactly clear why all the reasons someone may start or have difficulty stopping skin picking. This means skin picking is not always preventable. Avoiding or stopping using the drugs that cause skin picking is a way to prevent skin picking in the future. Support for combatting addictions that lead to skin-picking behavior like methamphetamines, cocaine, and heroin is available.
If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

Skin picking can be caused by consuming substances like methamphetamines, cocaine, heroin, and even prescription medications that are taken as directed. Skin picking can lead to damage, bleeding, infection, and scarring, as well as psycho-social effects such as social withdrawal and anxiety and depression. Treatment will be tailored to the cause but may include medications to help with symptoms and therapy to help change behavioral patterns leading to skin picking.

While certain use and misuse of drugs is a cause of skin picking, this is not always the case. People may also skin pick due to mental health conditions. If you notice skin picking on a loved one, avoid jumping to conclusions. If you're concerned about a loved one's potential use of drugs or mental health, reach out to them, be non-judgemental, and offer support.
Besides drug use, skin picking can be caused by a mental health disorder. Skin picking disorder (also known as excoriation or dermatillomania) is associated with obsessive compulsive disorder or body-focused repetitive disorders. Skin picking can also be a side effect of prescription medications.
Skin picking disorder is not very common with an estimated 2-5% of people experiencing it in their lifetime. But skin picking due to drug use is much more difficult to estimate as not everyone who engages in this behavior as a result of drug use will seek support or treatment. 

Healing picked skin first requires a person to stop picking at the skin and surrounding area. This may require medications to help with urges and therapy to change behavior, as well as lifestyle modifications such as stopping any drug use causing skin picking urges or changing medications if skin picking is a side effect. Healing picked skin may require antibiotic ointment if infection has occurred. If extreme damage has been done, skin grafting to repair the area may be necessary.

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By Michelle Pugle
Michelle Pugle, BA, MA, is an expert health writer with nearly a decade of contributing accurate and accessible health news and information to authority websites and print magazines. Her work focuses on lifestyle management, chronic illness, and mental health. Michelle is the author of Ana, Mia & Me: A Memoir From an Anorexic Teen Mind. 

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