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.

Several similarities between skin picking and substance use disorders (addictions) have been demonstrated, including:

Failure to stop the picking behavior despite knowing the potential consequencesSome level of pleasure while engaging in the activityNegative impact on self-esteem, mental health, or level of opportunities

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. 

Drugs that Cause Skin Picking

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.

Methamphetamines

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

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

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.

Prescription Medicines

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:

Adderall (dextroamphetamine-amphetamine) Dexedrine (dextroamphetamine sulfate) Vyvanse (lisdexamfetamine dimesylate)

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.

Risks & Complications of Skin Picking

Skin picking is not without consequence. There are mental, social, and physical effects associated with chronic skin picking.

Acknowledge there is a problemAvoid being judgemental of yourself or othersSeek or offer supportExpect some challenges in recovery (including desire to use again)Offer yourself or loved one lots encouragement and praise for changed behavior (big and small changes)Have a plan to cope with temptations (ie. , avoid people, places, and things where drug use is normalized)

Psychological and social effects of skin picking include:

Embarrassment Shame Distress Anxiety Depression Social withdrawal and isolation Hours spent on skin picking Interference with school and work

Physical effects of skin picking include:

New woundsReopening old woundsBleedingPain during and after pickingScarringInfection

Treatment 

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.

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.

Prescription Medications

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.

Therapy

Several forms of therapy may be used in the treatment of skin picking. Different therapies for skin picking include:

Habit reversal therapy: Helps someone become aware of the problem to then be able to change behavior Group or peer support therapy: Offers community and feelings of not being alone in their treatment Cognitive behavioral therapy: Provides tools on how to change behavior Mindfulness-based or acceptance-based therapy: Teaches someone how to accept certain emotions that may be leading to skin-picking behavior, such as anxiety

Prevention

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.

Summary

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.

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

A Word From Verywell

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.