How Does the Skin-Brain Connection Drive Skin-Picking Disorder?

Skin disease, mental health, and social context are deeply interconnected, according to Xiaofeng Yan, MD, and James Bourgeois, OD, MD, who highlighted psychodermatology as an underrecognized area at the interface of psychiatry and dermatology. Skin-picking disorder is not merely a habit but reflected a brain-skin interaction, with anxiety, emotional dysregulation, and sensory urges driving repetitive behaviors. "We see a clear brain skin interaction where anxiety and emotional dysregulation and sensory urges drive repetitive behaviors that can lead to significant physical and psychological impact," Yan said.¹

In patients with chronic inflammatory skin diseases, particularly those in sexual and gender minority populations, additional layers of stress like stigma and barriers to care contribute to higher rates of anxiety, depression, and substance use, often used as a coping mechanism. These conditions were framed as biopsychosocial rather than purely dermatologic, requiring integrated care models addressing the skin, mind, and social determinants of health together. Yan recommended that dermatologists screen for depression and anxiety and refer patients to psychiatry when indicated, noting that treating the skin alone was insufficient when another component of care was being missed.

The interface was bidirectional, Bourgeois noted: dermatologic complications were also among the more dangerous side effects of psychotropic medications, occurring commonly with lithium and anticonvulsants, with some manifestations being life-threatening. "Some of the more dangerous side effects of psychotropic medications are dermatological complications very common in lithium, numerous anticonvulsants, some of them are even dangerous life-threatening conditions," Bourgeois said.² He emphasized that both prescribing psychiatrists and evaluating dermatologists needed to remain attuned to this bidirectionality and collaborate when necessary, an approach encouraged through interspecialty collaboration and continuing medical education activities. Bourgeois noted that psychodermatology was one of several such cross-specialty interfaces, alongside psycho-oncology, cardiac psychiatry, and transplant psychiatry.

Yan pointed clinicians to the Association for Psychoneurocutaneous Medicine of North America and a corresponding European psychodermatology association as resources. The overarching message was that a multidisciplinary, integrated care model addressing skin, mind, and social context together was needed to improve patient outcomes and quality of life.

Dr Yan is an attending psychiatrist at NorCal Neurostimulation and a volunteer assistant professor in the departments of dermatology and psychiatry at UC Davis.

Dr Bourgeois is vice chair of Hospital Psychiatry Services and a professor at UC Davis Health in Sacramento, California.

References

1. Modanlo N, Yan X, Bourgeois JA. Pharmacologic management of skin-picking disorder: an updated review. J Acad Consult Liaison Psychiatry. 2025;66(5):417-428.

2. Mufaddel A, Osman OT, Almugaddam F. Adverse cutaneous effects of psychotropic medications. Expert Rev Dermatol. 2013;8(6):681-692.