Substance Abuse and Skin Picking

Drug misuse can cause skin picking, affecting every organ in your body. Drug misuse affects every organ in your body, including your skin, which is the largest organ in your body. Hair tugging and Skin picking are two typical reactions to illicit drug use’s physical and mental effects. The use of meth and heroin will leave needle scars and pus on the skin. Fear, restlessness, or crawling feelings cause many users to scratch their faces or arms compulsively(skin picking). The urge for skin picking is often caused by opiate withdrawal symptoms such as anxiety and goosebumps.

The compulsive urge for skin picking can fade after recovery. However, for specific users, this disorder continues long though they have stopped taking the medications. Skin picking would then be handled as another condition requiring behavioural changes and maybe psychiatric treatment.


Skin picking, also known as dermotillomania, is a “body-focused obsessive activity” (BFRB). A person with a BFRB has no power to end the behaviour, even if it causes them unwanted attention and physical injury from anyone. Hair grabbing, cheek chewing, and cuticle or nail digging are examples of BFRBs. According to the American Association for Marriage and Family Therapy, BFRBs can also coexist with different psychiatric conditions.

  • Depression 
  • Anxiety
  • Psychiatric conditions
  • Abuse of drugs and alcohol

According to a Journal of Clinical Psychiatry study, many people who indulge in skin picking suffer from other psychiatric illnesses. All 34 patients in this report, which took place in a dermatology centre, had at least a psychiatric diagnosis. The most common mood disorders were depression and bipolar disorder. Lots of partakers reported that depression or drug abuse run in their families. Dermotillomania is defined as an impulsive control disorder in mental health.

It’s Not Always Easy to Resist

It’s difficult to fight the temptation to itch, pull, poke, or scratch at sores and imperfections on the skin when you have compulsive skin picking.

According to the  American Journal of Drug Abuse, pathologic skin picking, this affects greater than 5% of the entire populace and a larger proportion of individuals who have a mental illness, exhibits many characteristics with drug abuse condition:

  • The behavior is associated with enjoyment and psychological relaxation for the person.
  • The conduct hurts the individual’s life, preventing them from engaging in professional, recreational, or social activities.
  • Despite the adverse effects, the person can’t stop the behavior ( bleeding, pain, infection, scarring, etc.).
  • The conduct triggers shame, regret, and self-hating, but the person continues to pick her skin despite her attempts to stop.

Females are more likely than males to be skin picking, but both genders suffer from this condition. Hair pulling, also known as trichotillomania, can create a short-lived rush of gratification that is as hooking as substance addiction. This abuse must be handled with behavioural intervention therapy, anti-anxiety medicine, and comprehensive counselling as part of the rehabilitation process.

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The Link Between Addiction and Skin Picking

When a person finds an imperfection on their skin, such as a scab or scar, they develop skin picking disorders. They start picking at the defect, causing more damage to the area and preventing healing. This leads to a vicious loop in which the skin picking addiction wins. Skin picking is particularly risky for those suffering from heroin itching or meth mites (also known as meth sores).

Illegal drugs like cocaine, methamphetamine, and heroin negatively impact your skin’s well-being. Heroin is a CNS depressant that delays heart rate, blood circulation, respiration, bodily functions, and metabolic rate.

Irritation from heroin and meth mites can cause sores to worsen, and someone with a skin picking addiction will continue to pick at them. Worse yet, the stress of detox may cause patients to pick at their sores, scabs, or skin even more, especially if they have anxiety or skin picking disorders.

What Drugs Cause Skin picking?

This may be a sign that they’re struggling with a substance abuse problem, particularly if other unusual or uncharacteristic behaviours accompany it. Scabs or skin lesions linked to drug abuse may be caused by various factors, depending on the drugs used. Various medications may cause these skin patches, sores, or scabs. Let’s take a look at the most common medications that cause skin problems in addicts.


 Meth, also known as crystal meth or methamphetamine, is possibly the most known substance on the list for causing severe skin picking. The open sores are caused by frequent meth use, often known as meth sores, which are most likely the product of various psychological and physical side effects that regularly consume this extremely addictive substance. Meth use can have severe physical and mental health consequences.

Poor sanitation, sweating out contaminants, a compromised immune system, and compulsive skin picking is also caused by “meth mites” (common hallucinations of insects or bugs crawling on or in the skin) are all examples of how meth use causes skin lesions or scabs. Meth also causes blood vessels to constrict, causing the skin to heal at a much slower rate. Meth sores can occur anywhere on the body, including inside the mouth, referred to as “meth mouth.”


Cocaine is a highly addictive substance that has been known to cause skin picking, lesions or scabs, depending on how it was consumed, such as snorting, injecting, or smoking it. The following are some of the most common skin problems associated with daily cocaine or crack use:

  • Necrosis, or the death of skin cells, is a common side effect of injecting the drug.
  • The blackening of the fingers or palms caused by smoking cocaine is known as “Crack Hands.”
  • Bad blood flow causes frequent or recurrent skin ulcers, as well as open sores.
  • Pustulosis is a skin condition characterized by tiny pimple-like bumps filled with pus and pop and bleed.
  • A hypersensitive reaction to drugs or infections that triggers skin eruptions and patchy red rashes is known as Bullous erythema multiforme.

These are only a few of the most common side effects of cocaine use on the skin. Cocaine, like most products, is highly poisonous, and it is often cut or mixed with other hazardous chemicals.


Other medications that have been linked to skin picking, lesions, skin sores, and scabs include opium, black tar heroin, and other opioids. Many of these substances are highly hazardous and addictive. Opiates, like many other dangerous and harmful substances, cause health problems that aren’t just skin-related. The effects of heroin on the skin are most commonly seen in users who inject the drug on a regular or semi-regular basis. 

Venous sclerosis is a disease caused by prolonged skin penetration when looking for a vein. Venous sclerosis can cause permanent scarring, referred to as “road lines.” It may also lead to skin infections, cellulitis (a potentially lethal bacterial skin infection), and skin abscesses, among other things. People who inject heroin daily are more likely to develop skin abscesses, which, like cellulitis, may become very severe if left untreated.

Injecting drugs with needles can result in severe skin picking, skin sores and lesions around the injection site.

Another source of concern for heroin users is the process known as “skin popping” on the streets. Instead of injecting the drug into the vein, it is inserted directly under the skin, subcutaneously, or even intramuscularly. As locating a vein becomes more complex, necrotizing skin lesions are a common side effect of this famous procedure. Unfortunately, heroin users are often susceptible to obsessively skin picking, which raises the risk of infection. Heroin patients, like many people who suffer from addiction, often neglect their hygiene. Together, these factors increase the likelihood of skin picking, lesions, and scabs.

Prescription Medicines

Similarly, some prescription drugs, particularly when abused, have been known to cause skin lesions or rashes. Hives, rashes, skin picking and hypersensitivity, are typical side effects of prescription stimulants, such as those used to treat ADD/ADHD. Since these reactions are almost always classified as allergic, not everyone can encounter them. Symptoms of an allergic reaction to prescription stimulants include fluid-filled bumps that can burst and scab over, as well as swelling, blistering, and peeling.

If you’ve recently started taking prescription stimulants and are experiencing some of these symptoms, see a doctor as soon as possible to get help before your condition gets worse. Both of these symptoms have the potential to be life-threatening, so you should seek medical help as soon as possible. There is no medicine worth the long-term damage that long-term drug use can do to your body or mind. Drug abuse is related to many other, much severe health problems.


By blocking these essential functions, heroin decreases the amount of oxygen to the skin. The skin can become cold, dry, flaky, and itchy due to heroin addiction, so they start skin picking. When heroin is injected intravenously, it may result in dangerous abscesses, mainly if the needles are dirty.

The habit of injecting heroin beneath the topmost layer of their skin, known as “skin popping,” leaves distinctive circular sores on the skin’s surface. The sores are easily infected and can leave lasting scars. Scabs may become obsessive skin picking objects for nervous, restless, or cravings users. Cellulitis, or inflammation of those soft tissues under the dermis, is increased when sores are picked at.

In addicts that use methamphetamine heavily, skin lesions are usual. This central nervous system stimulant induces delusional parasitosis, a disorder in which the user believes they are riddled with organisms crawling over their body. According to the University of California at Davis, if the user is severely intoxicated, this disorder, commonly called “cocaine bugs” or “meth mites”, leads to serious self-mutilation and skin picking.

Withdrawal from Heroin and Skin Picking

While detoxing from heroin, a very addictive opiate can be excruciatingly painful, drug cravings and goosebumps can provoke the desire to self-harm. Users in withdrawal often describe themselves as “crawling out of their skin,” and skin picking provides a temporary sense of relief in this state.

The skin is affected by heroin withdrawal in several ways. While the brain responds to this potent drug’s absence, goosebumps, cold sweats, shivering and chills appear. The bumps are created due to tiny muscles tightening underneath the skin’s fine hairs. Uncontrolled skin picking may help someone in withdrawal cope with restlessness feelings and cold

Self-mutilation and skin picking also helps opiate users deal with their cravings. The relief or pain feelings serve as a temporary diversion from using heroin. Ritualistic selection can create a way for withdrawal’s extreme anxiety, nervous stress, and restlessness.

However, skin picking only offers short-lived relief from opiate withdrawal symptoms. Physical withdrawal symptoms will last for a long period once they start. Entering a medically controlled detox program is the safest way to prevent withdrawal symptoms such as sweats, muscle pain, and goosebumps. A detox clinic will provide them with the emotional help and physical they need to relieve withdrawal symptoms and prevent relapse.

Skin Picking Treatment

A thorough medical assessment must precede medication for body-focused repetitive behaviours.

These Areas Should be Covered in An Original, Tailored Review:

  • What is the source of the skin picking?
  • What is the benefit of skin picking to the individual?
  • Is there a history of co-occurring mental health conditions, such as anxiety or depression?
  • Is there a problem with alcohol or drugs with the person?
  • Is there a family record of mental illness and skin picking?
  • Have they tried any drugs or treatments before?

While the FDA is yet to approve any specific medicines for the treatment of BFRBs, some medications have been successfully used to regulate impulsive skin picking. These drugs are listed as potentially helpful by the Trichotillomania Learning Center:

  • SSRIs, such as escitalopram (Lexapro) and fluoxetine (Prozac), are prescribed to treat obsessive-compulsive disorder and depression.
  • imipramine and Amitriptyline (Elavil) are tricyclic antidepressants (Elavil)
  • Naltrexone (ReVia) is a type of Opioid antagonists, and it is used to alleviate alcohol and other opioids’ pleasurable effects.
  • Obsessive-compulsive disorder is treated with neuroleptic drugs, including risperidone (Risperdal) and olanzapine (Zyprexa).

Behavioral treatment treatments such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) can help mitigate the desire for skin picking in addition to medication. These treatments have also been shown to be effective in treating opioid addiction.

Alternative Methods of Treatment

Alternative treatment modalities such as guided meditation, biofeedback, hypnotherapy, and acupuncture may help a recovering addict better regulate anxiety-related behaviors and relieve stress.

Treating Obsessive Behaviors

Like substance dependence, skin picking or hair tugging are compulsive, self-destructive habits. Mental health experts at Foundations Treatment spaces are aware of the complex relationship between abuse and impulse control conditions. Dual Diagnosis recovery services are uniquely designed to assist you in resolving mental disorder and substance misuse issues. Call 615-490-9376, and one of our admissions coordinators will walk you through the treatment plans and get you on the road to recovery from skin picking as quickly as possible.