What Is Skin Picking Disorder?
Drug addiction can cause a variety of skin problems, including skin picking, also known as excoriation. The skin picking disorder is considered a “body-focused obsessive activity”. When a person struggles with a body-focused obsessive activity, they have no power to end the behavior. Other examples of body-focused obsessive activity are hair grabbing, cheek chewing, and cuticle or nail digging.
According to the American Journal of Drug Abuse, pathologic skin picking disorder affects more than 5% of the entire population with a higher proportion of those with mental illness, in particular drug addiction. The behavior provides a certain level of enjoyment and comfort for the person despite it having potentially negative consequences such as bleeding, pain, infection, scarring, etc. The behavior may also trigger shame, regret, and self-hating, but the person continues to pick their skin.
Skin picking disorder may also be a sign that a person is struggling with a substance abuse problem, particularly if the behavior is accompanied by other strange or unusual behaviors from the individual. Depending on the drugs used, the person may develop skin lesions such as skin patches, sores, or scabs. If you notice yourself or a loved one experiencing these skin issues, it is important to consult a professional.
Drugs that cause skin picking disorder in those with addiction
The most common of drugs that cause skin picking disorder is probably methamphetamine or meth (otherwise known as crystal meth). In addicts who abuse methamphetamine regularly, skin lesions are relatively common. The skin picking disorder often leads to very prominent open sores, often referred to as ‘meth sores’ and is due to a combination of psychological and physical side effects related to frequent abuse of methamphetamine.
This drug can induce delusional parasitosis, a disorder in which the user believes they are covered with organisms crawling over their body, known as ‘meth mites’. This is a common hallucination experienced by methamphetamine users where they hallucinate that there are insects or bugs crawling on their skin. This constant skin picking, combined with poor hygiene, a compromised immune system can lead to skin scabs and lesions. Methamphetamine also causes blood vessels to constrict which leads to a slower healing time of the skin lesions. When the meth sores occur in the user’s mouth, it is referred to as ‘meth mouth’.
Cocaine is another common drug that causes skin picking disorder. When a person injects cocaine, there can be the death of skin cells or necrosis. When cocaine is injected, it can also lead to a hypersensitive reaction rash or skin infections that lead to pustulosis (pimple-like bumps that pop and bleed). Users who smoke cocaine can have blackened fingers or palms which are referred to as ‘crack hands’. Users can also experience a sensation called ‘cocaine bugs’ which is similar to ‘meth mites’, which can lead to serious skin picking disorder and self-mutilation.
Heroin often leads to skin lesions in people who inject the drug regularly. For users who inject drugs, the act of looking for a vein can lead to venous sclerosis which can lead to permanent scarring of the skin known as ‘road lines’. The repeated injections can also lead to skin infections, cellulitis, skin abscesses. These infections can become very serious if not treated medically. This can also lead to skin picking disorder around the injection site. Heroin users also engage in ‘skin popping’ where the drug is injected subcutaneously under the skin instead of into the vein or intramuscularly into the muscle.
This can predispose a user to necrotizing skin lesions and continued skin-picking of scabs and lesions. ‘Skin popping’ leaves distinctive circular sores on the skin’s surface. The sores are often easily infected and can leave permanent scars. Scabs may also become the target for obsessive skin picking disorder when a user is nervous, restless, or craving a drug. There is also an increased risk of cellulitis or inflammation of the soft tissue under the skin if a person continues to pick up and also has poor hygiene.
Users who are withdrawing from heroin can also experience a sensation of ‘crawling out of their skin’ where users may use skin picking as a way of relief from the side effects and drug cravings associated with detoxing from heroin. Skin picking disorder can also provide a temporary release from anxiety and restlessness. Skin picking disorder is also common when withdrawing from other medications such as opiates.
Other prescription drugs
There are certain prescription medications, when abused, which can also lead to skin lesions and skin picking disorder. Certain prescription stimulants, such as those used to treat Attention-Deficit/Hyperactivity Disorder (ADHD) can also lead to hypersensitivity reactions or hives and rashes. As a result of these allergic reactions, there can be the appearance of fluid-filled bumps that burst and scab over, resulting in sores that can be the target of picking. This is usually a sign of an allergic response so it is important to let your physician know that you had this reaction so they can adjust your medications accordingly.
Other Skin Conditions Caused By Drug Addiction
Drug abuse can wreak havoc on many of the body’s organs. Alcohol abuse puts tremendous strain on the liver, cocaine can significantly stress the heart, and heroin can damage the kidneys. That damage can remain hidden for many years since it is impossible to see the harm without sophisticated medical imaging systems.
You may not think of it in this way, but the skin is also an organ. It happens to be our largest organ. Abusing any of a wide range of drugs over a period of time can cause a variety of infections, sores, inflammation, or even rotting of the skin.
This damage may be caused by any of four factors, or a combination thereof:
- The drug itself
- Impurities used to cut the drug or that make their way into drugs sold on the street
- How the drug is delivered (e.g., intravenous use)
- Unhealthy behaviors that lead to skin problems, such as poor diet, lack of sufficient sleep, and failure to maintain adequate personal hygiene
Let’s look at some of the effects different drugs can have on the skin.
Cocaine’s Effect on the Skin
Cocaine can affect many different bodily systems. It can affect the skin itself and also some internal organs and systems that can result in damage to the skin.
The list of damaging dermatological diseases is a long one, but it includes:
- Necrosis, or death of skin cells
- The formation of fibrous tissue in the skin
- Blackening of the palms, also called “crack hands”
- Chronic skin ulcers
- Pustulosis, which are small, raised areas of the skin filled with pus
- Schonlein-Henoch vasculitis, which inflames blood vessels within the skin, causing the formation of red spots that can bleed
- Buerger’s disease, which inflamed veins in the extremities, causing them to swell and turn red
- Bullous erythema multiforme, which creates skin eruptions
Cocaine has also been known to have been cut with a variety of substances, some of which can have serious side effects. A report from 2016 out of the United Kingdom found that approximately 65–80 percent of the cocaine sold in the UK and the United States was cut with a deworming agent for livestock called levamisole.
Ingested over a long period of time, levamisole built up to sufficient levels in the systems of heavy cocaine users to cause ulcerating skin lesions and even rotting of the skin. It has also been linked to a drop in infection-fighting white blood cells, leaving some users vulnerable to any of a number of opportunistic infections.
Phenacetin is another cutting agent used in cocaine. This painkiller has been banned in the US since 1983, as it has been linked to a significantly heightened risk of contracting bladder cancer. The presence of phenacetin compounds the risks of levamisole in cocaine samples.
Methamphetamine and the Skin
Users who inject methamphetamine, as well as cocaine, heroin, or any injectable drug, are at great risk for skin infections. One study published in the British Journal of Dermatology found that 11 percent of IV drug users reported at least one abscess within the previous six months.
How Alcohol Affects the Skin
It is widely known that abuse of alcohol puts a tremendous strain on the liver and can even lead to cirrhosis, a life-threatening disease that results from scar tissue building up in the liver. But alcoholic liver disease can also cause problems visible on the skin.
One of the most common is spider angioma. These are lacy patches of red that usually appear on the hands, face, neck, or torso and are thought to be caused in part by alcohol-induced vasodilation. Caput medusa, also known as palm tree sign, is another disfiguring skin condition, resulting in swollen and distended veins, which appear around the navel and spread across the abdomen. This often indicates severe liver disease.
Jaundice, a yellow discoloration of the skin and mucous membranes, occurs when there are high levels of serum bilirubin. Jaundice often points to many varieties of liver disease. Alcohol has been indicated in increased activity of enzymes associated with a condition called porphyria cutanea tarda, or PCT, which can cause scarring in areas of the skin exposed to the sun.
Psoriasis in those who suffer from alcohol use disorder has been shown to have a distinct array of flat, thick, red plaques over the surfaces of the hands, fingers, palms, and soles of the feet, and doctors believe that alcohol abuse may exacerbate psoriasis. Other dermatologic conditions linked to alcohol abuse include eczema, rosacea, and seborrheic dermatitis.
Reclaim Your Life From Skin Picking Disorder
Skin picking disorder is a serious condition that should not be taken lightly. We Level Up Treatment Center can provide you, or someone you love, the tools to recover from skin picking disorder with professional and safe treatment. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.
 Ciccarone, D., & Harris, M. (2015). Fire in the vein: Heroin acidity and its proximal effect on users’ health. The International journal on drug policy, 26(11), 1103–1110. National Library of Medicine
 CDC – Scopolamine Poisoning among Heroin Users — New York City, Newark, Philadelphia, and Baltimore, 1995 and 1996
 National Institute on Drug Abuse – What are the long-term effects of methamphetamine misuse?
 Gupta MA, Schork NJ, Gupta AK, Ellis CN. Alcohol intake and treatment responsiveness of psoriasis: a prospective study. J Am Acad Dermatol. 1993 May;28(5 Pt 1):730-2. National Library of Medicine