Skin picking, also known as dermatillomania or excoriation disorder, is a compulsive behavior that leads to red scabs on skin, open wounds, and long-term scarring. While it can be a standalone disorder, many people experience skin picking as a side effect of drug use—both illicit and prescription drugs.

If you or a loved one has developed compulsive skin picking, it’s important to understand which drugs can trigger this behavior, why it happens, and what you can do to stop it.

How Drug Use Causes Skin Picking

Drugs that cause skin picking affect the brain’s reward and sensory systems, often by altering dopamine levels. This disruption can lead to several consequences that contribute to the development of skin picking behaviors.

Key Reasons Drugs Lead to Skin Picking

• Formication: The sensation of bugs crawling under or on the skin, causing extreme distress and leading to compulsive scratching and picking.
• Increased Anxiety or Restlessness: Many drugs cause heightened nervous energy, leading to nail biting, repetitive scratching, or compulsive skin picking as a coping mechanism.
• Delayed Healing: Drugs constrict blood vessels, reducing blood flow to wounds and prolonging recovery time for scabs and sores.

For some individuals, drugs worsen pre-existing dermatillomania, while others may develop skin picking behaviors due to drug use. Understanding these mechanisms is crucial for addressing and treating drug-induced skin picking.

What Drugs Cause Skin Picking?

Methamphetamine (“Meth Mites” and Severe Picking)

Methamphetamine is one of the most well-known drugs that cause skin picking. Meth users often develop severe, open wounds known as “meth sores,” caused by compulsive scratching and picking at their skin.

• Methamphetamine use can cause formication, the hallucination of bugs crawling under the skin—often referred to as “meth mites.”
• This leads to intense scratching, red scabs on skin, and infections.
• Meth constricts blood vessels, slowing healing time and increasing the risk of permanent scars.
• Poor hygiene among meth users worsens infections, leading to long-term skin damage.

The psychological impact of meth-induced skin picking should not be underestimated. Users often experience distress, guilt, and worsening mental health symptoms, creating a self-destructive cycle of picking and drug use.

Cocaine (“Coke Bugs” and Self-Mutilation)

Cocaine is another drug that makes you pick at your skin. Similar to meth, cocaine can cause hallucinations of parasites crawling under the skin, leading to obsessive scratching and severe skin damage.

• Cocaine-induced psychosis makes users believe insects or parasites are under their skin, leading to self-mutilation and deep wounds.
• Pustulosis (pimple-like bumps that pop and bleed) can develop from long-term cocaine use.
• Some users experience “crack hands,” where blackened fingers and palms develop due to smoking cocaine.
• Cocaine use can lead to social withdrawal due to visible scars and wounds, further complicating the psychological toll.

Addressing cocaine-induced skin picking requires a comprehensive approach, including medical treatment, therapy, and support for addiction recovery.

Heroin and Opioids (Itching and Skin Picking During Withdrawal)

Heroin users frequently engage in skin picking due to:

• Histamine release, which causes intense itching and leads to constant scratching and skin sores.
• Repeated injections leading to skin infections and venous sclerosis (“road lines”).
• “Skin popping,” a method of injecting heroin under the skin, causes circular sores that are prone to infection and obsessive picking.

During heroin withdrawal, users often experience a sensation of “crawling out of their skin,” which can lead to excessive picking and self-inflicted wounds.

Prescription Drugs That Cause Skin Picking

ADHD Medications (Adderall, Vyvanse, Ritalin)

Some people taking prescription drugs for ADHD, such as Adderall, Vyvanse, and Ritalin, develop compulsive skin picking as a side effect. These medications work by increasing dopamine levels, which can trigger repetitive behaviors like skin picking, nail biting, or lip chewing.

• Hypersensitivity reactions can cause fluid-filled bumps that burst and scab over, leading to excessive picking.
• Dry skin, rashes, and itching make people more likely to pick at irritated areas.

If you notice compulsive picking after taking ADHD medication, consult your doctor about adjusting your dosage or exploring alternative treatments.

Other Prescription Drugs That Can Lead to Skin Picking

• Certain antidepressants and anticonvulsants can trigger obsessive-compulsive behaviors.
• Corticosteroids may cause itching and hypersensitivity reactions, leading to compulsive scratching and picking.
• If prescription drugs are making you pick at your skin, consult your doctor to explore alternative medications.

Signs and Symptoms of Drug-Induced Skin Picking

Not everyone who picks at their skin does so because of drug use, but if the behavior starts or worsens after taking certain substances, drugs may be a contributing factor.

Physical Signs

• Red scabs on skin, open wounds, and sores that don’t heal.
• Constant scratching and picking at the same areas.
• Infections due to broken skin and poor hygiene.

Psychological Signs

• Compulsive urge to pick, even when it causes pain or bleeding.
• Temporary relief after picking, followed by guilt or distress.
• Skin picking as a response to stress, withdrawal, or drug cravings.

The Dangers of Drug-Induced Skin Picking

Infection Risks

Constant skin picking breaks the skin barrier, increasing the risk of bacterial infections like MRSA and cellulitis.

Permanent Skin Damage

Repeatedly picking at scabs prevents healing and leads to deep scars, hyperpigmentation, and even skin grafting in severe cases.

Mental Health Consequences

People who compulsively pick due to drug use often experience:

• Shame and embarrassment about their appearance.
• Increased anxiety and depression.
• Social withdrawal due to visible scars and wounds.

Treatment for Drug-Induced Skin Picking

Medications for Skin Picking

Doctors may prescribe skin picking medication to help control compulsive behaviors:

• SSRIs (Selective Serotonin Reuptake Inhibitors): Used for obsessive-compulsive disorders and dermatillomania.
• N-acetylcysteine (NAC): Helps regulate dopamine and reduce skin picking behaviors.
• Anticonvulsants: Some help control compulsive urges.

Therapy for Skin Picking

• Cognitive Behavioral Therapy (CBT) – Helps individuals understand triggers and replace compulsive behaviors.
• Habit Reversal Training (HRT) – Teaches techniques to interrupt picking behaviors.

Conclusion

Certain drugs—both illicit and prescription—can cause compulsive skin picking, red scabs on skin, and permanent scars. Meth, cocaine, heroin, and ADHD stimulants like Adderall and Vyvanse are some of the most common culprits.

If you or someone you know is struggling with drug-induced skin picking, seek professional help today. Therapy, medication adjustments, and addiction recovery support can help break the cycle and prevent further damage.

FAQs About Drugs That Cause Skin Picking

What drugs make you pick at your skin?

Several illicit and prescription drugs can cause compulsive skin picking, including:

• Methamphetamine (“Meth Mites”) – Leads to hallucinations of bugs crawling under the skin, causing excessive scratching and red scabs on skin.
• Cocaine (“Coke Bugs”) – Induces formication, leading to severe self-inflicted wounds.
• Heroin and opioids – Cause intense itching and skin irritation, leading to skin sores and compulsive picking behaviors.
• ADHD Medications (Adderall, Vyvanse, Ritalin) – These stimulants can cause dopamine-induced repetitive behaviors, including nail biting, lip chewing, and compulsive skin picking.

What drug causes you to pick at your skin the most?

Among drugs that cause skin picking, methamphetamine (meth) is the most notorious. Meth users frequently experience severe skin picking due to hallucinations of insects (“meth mites”) crawling under their skin. This condition, known as formication, leads to open sores, red scabs, and long-term scarring. Cocaine and heroin are also commonly associated with compulsive picking.

Why do drugs cause skin picking?

Drugs that make you pick your skin affect dopamine levels in the brain, triggering compulsive behaviors. Some drugs, like meth and cocaine, cause hallucinations (formication), leading users to believe that bugs are crawling under their skin. Others, like heroin and prescription stimulants, cause intense itching, leading to excessive scratching, scabs, and wounds.

What prescription drugs cause skin picking?

Prescription drugs that cause skin picking include:

• ADHD medications (Adderall, Vyvanse, Ritalin, Dexedrine) – These stimulants increase dopamine levels, which can trigger repetitive scratching and skin picking behaviors.
• Certain antidepressants and anticonvulsants – Some medications used to treat OCD, anxiety, and depression can worsen compulsive behaviors like skin picking.
• Corticosteroids – Can cause itching, hypersensitivity reactions, and rashes, leading to compulsive scratching and scab formation.

How do I stop skin picking caused by drugs?

If prescription drugs are making you pick at your skin, talk to your doctor about:

• Adjusting your dosage or switching to an alternative medication.
• Using skin picking medication like SSRIs or N-acetylcysteine (NAC) to help manage compulsive behaviors.
• Incorporating therapy, such as Cognitive Behavioral Therapy (CBT) or Habit Reversal Training (HRT), to address skin picking triggers.

If illicit drugs are causing severe skin picking, seeking addiction treatment is crucial. Medical detox, counseling, and rehab programs can help reduce withdrawal symptoms and compulsive skin picking behaviors.

Are red scabs on skin a sign of drug use?

Red scabs on skin can be a sign of drug-induced skin picking, especially if the wounds:

• Appear repeatedly on the face, arms, or legs.
• Are accompanied by intense scratching and picking behaviors.
• Are paired with other signs of drug use, like paranoia, anxiety, or extreme restlessness.

If you or someone you know has red scabs from picking and is using drugs like meth, cocaine, or heroin, it may be time to seek medical and psychological support.

Can Adderall or Vyvanse cause skin picking?

Yes. Adderall and Vyvanse can cause skin picking, especially in people who are prone to compulsive behaviors. These stimulant medications increase dopamine, which can lead to:

• Obsessive skin picking, nail biting, and compulsive scratching.
• Hypersensitivity reactions, rashes, or dry skin that worsen picking.
• Increased anxiety, restlessness, or hyper-focus on repetitive behaviors.

If Adderall, Vyvanse, or other ADHD medications are making you pick at your skin, consult your doctor to explore dosage adjustments or alternative medications.

What happens if I keep picking at my skin from drug use?

Long-term skin picking from drug use can cause:

• Chronic infections (MRSA, cellulitis) due to open wounds.
• Permanent scarring and hyperpigmentation.
• Psychological distress, anxiety, and self-esteem issues.
• Increased risk of severe skin damage that may require skin grafting.

If you are struggling with drug-induced skin picking, seeking treatment for both the drug use and compulsive behavior is crucial to preventing further harm.

Is there medication to stop skin picking?

Yes, skin picking medication can help manage compulsive behaviors. Some options include:

• Selective Serotonin Reuptake Inhibitors (SSRIs) – Often used for dermatillomania and OCD-related skin picking.
• N-acetylcysteine (NAC) – A supplement that helps regulate dopamine and reduce skin picking urges.
• Anticonvulsants – Some medications have been shown to help control compulsive skin picking behaviors.

If your skin picking is linked to drug use, stopping the underlying drug or adjusting prescription medications can help reduce the behavior.

Can therapy help stop drug-induced skin picking?

Yes. Therapy is one of the most effective ways to stop skin picking from drug use. Options include:

• Cognitive Behavioral Therapy (CBT): Helps individuals identify triggers and develop alternative coping mechanisms.
• Habit Reversal Training (HRT): Teaches people to replace picking behaviors with healthier habits.
• Mindfulness-Based Therapy: Helps reduce stress-related picking.

For drug-related skin picking, therapy should be paired with addiction treatment to address both the compulsive picking and the substance use disorder.

Can skin picking be a withdrawal symptom?

Yes, skin picking is common during drug withdrawal, especially from heroin, meth, cocaine, and prescription stimulants. During withdrawal, individuals may experience:

• Severe itching and hypersensitivity, leading to increased picking.
• Extreme anxiety and restlessness, triggering compulsive behaviors.
• Formication (“crawling skin” sensation), leading to excessive scratching and sores.

If you or someone you know is experiencing skin picking during withdrawal, seeking medical detox and addiction treatment can help manage symptoms safely.

Informational Sources

• Cleveland Clinic. (n.d.). Dermatillomania (Skin Picking). Retrieved from https://my.clevelandclinic.org/health/diseases/22706-dermatillomania-skin-picking
• Grant, J. E., & Chamberlain, S. R. (2020). Neurocognitive findings in skin-picking disorder: A comprehensive review. Frontiers in Psychiatry, 11, 142. https://pmc.ncbi.nlm.nih.gov/articles/PMC7115927/
• Odlaug, B. L., & Grant, J. E. (2010). Pathologic skin picking: Prevalence, clinical features, and treatment options. Psychiatry Research, 178(1), 116-122. https://pubmed.ncbi.nlm.nih.gov/20575652/
• Snorrason, I., Belleau, E. L., & Woods, D. W. (2012). Acquisition of skin-picking behavior: A review and proposed model. Journal of Obsessive-Compulsive and Related Disorders, 1(2), 66-73. https://pmc.ncbi.nlm.nih.gov/articles/PMC2719449/
• Woods, D. W., Flessner, C. A., Franklin, M. E., Keuthen, N. J., Goodwin, R. D., Stein, D. J., & Walther, M. R. (2021). The prevalence and clinical characteristics of skin picking disorder. Comprehensive Psychiatry, 61, 111-118. https://pmc.ncbi.nlm.nih.gov/articles/PMC7910222/