Dermatophagia

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What is dermatophagia?

Dermatophagia translates to skin (dermato) eating (phagia). The disorder is actually a compulsion to gnaw or bite one’s own skin, not literally eat or ingest it. Because of this, some experts believe the term “dermatodaxia” is more suitable. It denotes skin (dermato) biting (daxia), but not consumption of the skin.

Doctors characterize the condition as a type of pathological skin picking (PSP). PSPs, in turn, are forms of a body-focused repetitive behavior (BFRB). BFRBs fall under obsessive-compulsive and related disorders in the American Psychiatric Association’s diagnostic handbook. It’s likely that about 1 in 20 people has some form of BFRB.

The most common type of dermatophagia involves biting skin around nails and cuticles. It often occurs along with onychophagia, which is nail biting. Other types of dermatophagia include:

  • Cheek biting
  • Lip biting
  • Tongue chewing

Everyone has likely engaged in one or more of these behaviors from time to time. Skin biting becomes a problem when it causes distress or interferes with daily functioning. It’s also problematic when dermatophagia causes physical damage, such as bleeding, scarring, or thickened skin.

BFRBs are different from self-mutilating behaviors. The intent of BFRB behaviors isn’t to harm oneself or cause pain as a distraction. Instead, these compulsive urges more likely grow out of a need to improve or correct imperfections. In this way, they are forms of overgrooming. They can also be a way of dealing with anxiety and other overwhelming or negative emotions. Unfortunately, physical damage is often the result of BFRBs, even if it isn’t the underlying intent.

Scientists do not fully understand what causes dermatophagia and other BFRBs. There is likely a genetic component, as family members often exhibit the same or similar behaviors. But there are likely other environmental factors and personality traits that lead to them. BFRBs are common in people who also suffer with ADHD (attention deficit hyperactivity disorder).

Cognitive behavior therapy (CBT) is the main dermatophagia treatment. CBT is a form of psychotherapy. It helps people identify problematic thoughts, feelings and behaviors, and change them. The specific form of CBT that is most helpful in treating BFRBs is habit reversal training (HRT). For some people, medicines before or during HRT can also be beneficial.

Dermatophagia isn’t a medical emergency. However, you should see your doctor if you are engaging in repetitive skin biting and can’t stop or decrease the behavior.

What are the symptoms of dermatophagia?

It’s common to display behaviors like nail or cuticle biting occasionally. If you think you may have a problem with them, seek help sooner rather than later. Treatment can help you get back to living life without the constant compulsion to bite your skin.

The main symptom of dermatophagia is a compulsive and repetitive biting of the skin. It can involve skin on any part of the body. The most common sites are the fingers, cuticles, and skin around the nails. Oral tissue, including the lips, tongue, and inside of the cheeks, are also common targets. This behavior can lead to bleeding, sores, and even infection. There is also a tendency to develop thickened skin in the area. On oral tissues, callus-like patches called keratoses can occur.

When physical damage occurs, it’s a sign that dermatophagia has become a problem. Other signs that it’s time to see a doctor include:

  • Allowing the behavior to interfere with daily function, have a negative social impact, or limit your life in some way
  • Feeling distress about the behavior
  • Lacking control over the behavior

What causes dermatophagia?

Like many mental health issues, the exact cause of dermatophagia is uncertain. There is likely an inherited component to it and other BFRBs. But other factors are likely involved. This may include a person’s temperament and environmental triggers. For some people, BFRBs are coping mechanisms for anxiety, stress and other negative or overpowering emotions. For others, they are a form of gratification from a compulsive need to fix imperfections.

BFRBs are generally forms of self-soothing. Most experts agree that BFRBs are not a sign of some underlying trauma or unresolved problem. This makes them different from self-mutilating behaviors, which are often related to interpersonal difficulties. In addition, people with BFRBs don’t intend to harm themselves, even when physical damage is the result of their behaviors.

What are the risk factors for dermatophagia?

Having an immediate family member with a BFRB increases the likelihood of developing one. Having ADHD may also predispose people to developing a BFRB, such as dermatophagia.

Reducing your risk of dermatophagia

Because scientists don’t fully understand how BFRBs develop, it’s nearly impossible to prevent them. If you are concerned about a behavior or your risk of a BFRB, talk with your doctor about it. Find out when and how to seek help.

How is dermatophagia treated?

Cognitive behavior therapy (CBT) is the main dermatophagia treatment. Of the different CBT methods, habit reversal training (HRT) is the most successful. Doctors consider HRT to be the method of choice for treating BFRBs. In HRT, therapists help people identify specific triggers, situations and emotions that result in the behavior. Then, they work to replace the behavior with a competing response, such as making a fist.

Social support of friends and family is important to making HRT successful. They can provide cues to use the competing response, encouragement, and positive feedback. This aids the person in becoming aware of triggers and replacing the behavior.

For some people, medicines are useful in conjunction with HRT. There are no approved medicines specifically for BFRBs. Instead, doctors use medicines that target underlying emotions or triggers, such as anxiety. Common examples include:

  • Clomipramine (Anafranil)
  • Naltrexone (Revia)
  • Olanzapine (Zyprexa)

Support groups can also play an important role in treating BFRBs. Because shame is common in BFRB sufferers, they may lose the drive to want treatment. Interacting with others who share the same challenges can help people stay on track with treatment.

What are the potential complications of dermatophagia?

People who bite their skin usually don’t intend to cause physical harm to themselves. Unfortunately, the behavior often leads to physical damage whether they intended it or not. This can include bleeding, sores, infection, tissue damage, and scarring. Repetitive biting can also lead to thickened skin in the area. The behavior and the damage it causes can lead to significant distress and interfere with normal daily life.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Sep 10
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Other Body-Focused Repetitive Behaviors. TLC Foundation for Body-Focused Repetitive Behaviors. https://www.bfrb.org/learn-about-bfrbs/other-bfrbs
  2. Are BFRBs Self-Harm? TLC Foundation for Body-Focused Repetitive Behaviors. https://www.bfrb.org/learn-about-bfrbs/289
  3. Body-Focused Repetitive Behaviors (BFRBs). Anxiety and Depression Association of America. https://adaa.org/body-focused-repetitive-behaviors
  4. Causes of BFRBs. TLC Foundation for Body-Focused Repetitive Behaviors. https://www.bfrb.org/learn-about-bfrbs/treatment/causes-of-bfrbs
  5. Expert Consensus Treatment Guidelines: Body-Focused Repetitive Behaviors Hair Pulling, Skin Picking, and Related Disorders. TLC Foundation for Body-Focused Repetitive Behaviors. https://www.bfrb.org/storage/documents/Expert_Consensus_Treatment_Guidelines_2016w.pdf
  6. Hair Pulling! Skin Picking! Nail Biting! Oh, My! ADDitude Magazine. https://www.additudemag.com/body-focused-repetitive-behaviors-adhd-depression-anxiety/
  7. Medications for Body-Focused Repetitive Behaviors. TLC Foundation for Body-Focused Repetitive Behaviors. https://www.bfrb.org/learn-about-bfrbs/treatment/self-help/186-medications-for-body-focused-repetitive-behaviors
  8. Mitropoulos P, Norton SA. Dermatophagia or dermatodaxia? J Am Acad Dermatol. 2005;53(2):365.
  9. Moritz S, Rufer M, Schmotz S. Recovery from pathological skin picking and dermatodaxia using a revised decoupling protocol [published online ahead of print, 2020 Mar 29]. J Cosmet Dermatol. 2020;10.