Medication Options for Skin Picking Disorder: Finding What Works

I often hear from families in our community about their concerns when they notice their child engaging in skin-picking behaviors. Today, I want to share some hope and practical information about medication options that might help.

First, Let's Understand the Basics

Skin picking can appear at any age, but we often see it emerge during the teenage years. Like many aspects of supporting our children, there's no one-size-fits-all approach. Some children may benefit from gentle behavioral strategies alone, others may need specific therapy. Many more moderate to severe cases need additional support through medication. 

Starting the Medication Journey

When families first come to me asking about medication options, I often start by explaining our "toolbox" approach. Think of each medication option as a different tool that might help your child – some work well on their own, while others work better in combination.

SSRIs: Our First Step

The medications we often try first are called SSRIs (medications like fluoxetine, sertraline, or escitalopram). Think of these as helpers that can make those picking urges feel less intense and easier to manage. Many parents in our community report that while their child may still have some urges to pick, they become more manageable – like turning down the volume on a loud radio. We think they work because skin picking is related to OCD, and SSRIS are our first line of defense for OCD.  

NAC: A Helpful Addition

One supplement that's shown promise is called N-Acetylcysteine (NAC). IT is an over-the-counter antioxidant supplement. What's interesting about NAC is that it can be used either on its own or alongside other medications. I usually see it work better when added to medications. We typically start with a lower dose (600mg twice daily) and may gradually increase it if needed, up to 3000 mg daily. One important thing I tell parents: patience is key here – it can take 8-12 weeks to see the full benefits.

Memantine: Another Tool in Our Kit

Some children, particularly those who struggle with both repetitive behaviors and emotional regulation, might benefit from a medication called memantine. In my experience working with autistic youth, this medication often works best when combined with other treatments rather than used alone. There are scientific trials for memantine when added onto other medications to decrease severity of skin picking. Like the SSRIs, it is also studied for OCD. It does not have many side effects, so many patients prefer this option to start!

Understanding Additional Options

Sometimes, we might consider other medications, especially if your child isn't finding enough relief from the first options we try:

• Antipsychotic medications can be particularly helpful for some children, especially when combined with other treatments. For example, some families have found that adding medications like aripiprazole, olanzapine, risperdal has made a significant difference when other approaches weren't quite enough. These medications can also be used for conditions like Tourette’s, tic disorders, and also decrease skin itching. Therefore, they may overlap in symptoms (urges to pick, like urges to tic), which may help some individuals decrease picking. 
• Additional options I consider when primary medications are not working include lamotrigine (especially helpful for mood stability), naltrexone, or hydroxyzine (which can help with both anxiety and physical sensations that trigger picking). While not FDA approved, I have had patients respond to these medications, or a combination thereof, when nothing else worked. 

Important Things to Know as a Parent

I always want to be completely honest with families: none of these medications are specifically FDA-approved for skin picking, and they usually do not cure the condition. However, this doesn't mean they aren't helpful – it simply reflects that we need more research in this area. Many families in our community have found relief through these treatment options when carefully monitored by their healthcare team.

A Note of Encouragement

Remember, finding the right medication or combination of medications is often a journey, not a sprint. It's okay to take time to find what works best for your child. Some families find the right solution quickly, while others need to try different approaches before finding their best fit.

What matters most is working closely with doctors who understand both autism and skin-picking behaviors. They can help guide you through these options while considering your child's unique needs and challenges.

If you're feeling overwhelmed or unsure about medication options, know that you're not alone. Our parent community has walked this path before, and many have found successful ways to help their children manage skin-picking behaviors.

Have questions about medication options or want to connect with other parents who understand? Consider joining our Autism Roadmaps Community, where you can find support, share experiences, and learn from other families on similar journeys.

Remember: You know your child best, and any decision about medication should feel right for your family. We're here to support you every step of the way.