Dermatillomania on the Scalp: Signs, Triggers, and Treatment
Your fingers go to your scalp, find a bump or a scab, and pick at it. Then you check the spot again. Because your hair hides it, scalp picking can go on for years before anyone notices, sometimes including you.
By Nathan Peterson, LCSW, OCD and BFRB therapistWhat Is Dermatillomania on the Scalp?
Dermatillomania, also called skin picking disorder or excoriation disorder, is repeated picking at your skin that causes damage, along with trying to stop and not being able to. Scalp picking is one of the most common forms.
It's a body-focused repetitive behavior, or BFRB, the same group as hair pulling and nail biting. It's not a willpower problem, and it's not a bad habit you should be able to quit cold turkey.
Signs of Scalp Picking
- Running your fingers through your hair looking for bumps, scabs, or rough spots
- Picking at scabs until they bleed, then picking them again once they heal
- Scratching or digging at flakes or dry patches
- Looking at or touching what you picked off
- Sore, tender, or scabbed spots you keep going back to
- Picking while you read, scroll, drive, or watch TV, often without noticing
- Wearing hats or styling your hair to hide the spots
Some people also pull hair while they pick, so scalp picking can overlap with trichotillomania.
Why Scalp Picking Is So Hard to Stop
Picking brings a moment of relief or satisfaction. A rough spot feels "wrong," and getting it smooth feels better for a second. Your brain remembers that, so the urge shows up faster next time.
The scalp makes it easier, too. It's always within reach, and your fingers can find spots by feel without a mirror. Common triggers include stress, boredom, being tired, sitting still, and the feeling of a new bump or scab.
What Scalp Picking Can Do to Your Scalp
Picking keeps sores from healing, so the same spots stay open or scab over again and again. Over time that can lead to infection, scarring, and thinning or patchy hair where the skin has been damaged.
If you have sores that won't heal, signs of infection, or hair loss, see a doctor or dermatologist for your scalp while you work on the picking.
Dermatillomania Scalp Treatment
The main treatment for skin picking is a behavioral approach made for BFRBs. It usually covers:
- Noticing. Learning when, where, and how you pick, so it stops happening on autopilot.
- Changing your setup. Making picking harder in your usual spots, like wearing a hat or a hair tie, or keeping your hands busy while you watch TV.
- Doing something else with the urge. Using a competing action, like pressing your fingertips together or holding something, until the urge passes.
I know, wearing a hat on your own couch sounds ridiculous. It works because it puts a second between the urge and your fingers, and that second is where you get to choose.
The urge doesn't have to disappear first. You let it hang around for a few minutes while your hands do something else. Some medications are being studied for skin picking, so that's a question for your doctor. More on excoriation disorder treatment.
Find the spot where you pick your scalp most, like the couch or the car, and leave a hat or something to fidget with there today.
Not sure if it's skin picking disorder? Take the free skin picking test.
Common questions about scalp picking
What is scalp picking?
Scalp picking is a form of dermatillomania, also called skin picking disorder or excoriation disorder. It means repeatedly picking at scabs, bumps, or flakes on your scalp, often until it bleeds or scabs over again.
Is scalp picking the same as hair pulling?
No, but they often overlap. Scalp picking is picking at the skin. Hair pulling, or trichotillomania, is pulling out the hair itself. Some people do both, and both are body-focused repetitive behaviors.
Why can't I stop picking my scalp?
Picking brings a moment of relief or satisfaction, and your brain remembers that. The scalp is also easy to reach and hidden by your hair, so it often happens without you noticing.
Should I see a doctor about scalp picking?
If you have sores that won't heal, signs of infection, or hair loss around the spots, a doctor or dermatologist can treat your scalp. A therapist who treats BFRBs helps with the picking itself.
How do you treat dermatillomania on the scalp?
The main treatment is behavioral. You learn to notice when and where you pick, change your setup to make picking harder, and do something else with your hands when the urge shows up.
