The biggest change for my skin picking came from habit reversal training, not just trying harder to stop. My therapist helped me notice the situations that set it off, especially when I was watching TV or stressed, then we worked out a replacement action. I keep a smooth stone nearby and use hand lotion when I get the urge, since greasy hands make picking harder.
CBT helped too, mainly because I stopped treating every slip like a total failure. I still have bad days, but the episodes are shorter and I catch myself sooner. Keeping my nails trimmed and covering spots that I tend to pick has made a difference as well.
Medication wasn’t a complete fix for me, but talking with a doctor about anxiety and possible options was useful. Finding a therapist who actually understood excoriation disorder mattered more than I expected. General advice like “just leave it alone” never did much.
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The part about noticing the trigger while watching TV really clicked for me. I can get so absorbed that I don’t realize what my hands are doing until I’ve already made the spot sore.
Using a replacement action sounds more practical than relying on willpower. I’m going to try keeping something textured nearby and using lotion, especially during stressful evenings. The reminder that a slip isn’t total failure is helpful too. Catching it sooner still counts as progress.
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@Robert_Walter, catching it after the spot is already sore is such a frustrating moment. I’ve found that putting the textured object where I usually sit works better than keeping it in a drawer, since I’m more likely to reach for it automatically.
One small thing that helped me was wearing a soft headband during TV, which made me notice my hand moving toward a problem area sooner. It didn’t stop every episode, but that extra pause gave me a chance to switch to lotion or the fidget.