The Perils of Picking


We are all familiar with images and commercials that show startlingly beautiful models with perfect bodies and flawless skin. Most of the time, we are aware these images promote an unattainable standard of beauty. Our brains know it, but emotionally it’s another story. The danger in these representations of perfection is the implication that this is only type of beauty that is desirable. They’re dangerous because for all women—young and old—this misconception can seriously affect their self-esteem.

“For those of us in the skincare industry, beauty starts with the skin. The skin is the backdrop, canvas and stage on which all our features are projected and on which we focus much of our work.”—Marion Simms, founder and owner of SkinSense Wellness

Furthermore, these images are pure fantasy because nobody can live up to this preordained standard of beauty, especially the cookie-cutter version presented by the commercial world. As a magazine editor friend of mine says, “Never forget that without makeup, lighting and Photoshop, even models don’t look like models.”

Amplification of Insecurity

It’s no secret that media has always been the major player in fostering insecurities over looks and it’s getting worse. With the advent of social media and selfies, we are even more aware of how we look. According to the American Academy of Facial Plastic and Reconstructive Surgery, increased photo-sharing has resulted in a higher demand for rhinoplasty, hair transplants and eye surgery, as well as injectable fillers and neurotoxins like Botox. A 2014 Dove study noted, “Five million disparaging tweets were posted by women about beauty and most of those were about themselves.” The results also showed that “women are twice as likely to say that their conception of beauty is shaped by women in the public domain.” When internalized, this punishing scrutiny can lead to unrelenting stress.

But there is a silver lining here. The same Dove survey concluded, “82% of women also said that they believed that social media can change prevailing standards of beauty.” A quick scroll through Facebook, Instagram and Twitter today endorses this view. Images of women candidly displaying their bodies, ethnicities and ages honestly and openly would seem to indicate a trend to celebrate individual beauty. In reality, beauty is everywhere. It is diverse, interesting and individual and an essential part of our humanity. It is our job as skincare professionals to celebrate the skin and bring out its best.

For those of us in the skincare industry, beauty starts with the skin. The skin is the backdrop, canvas and stage on which all our features are projected and on which we focus much of our work.

Compulsion to Pick

Many clients pick their skin, especially when they are stressed, even though they know it is harmful. Picking is addictive, often driven by an urge to punish or purge. In severe cases, it is referred to as an excoriation disorder. Psoriasis, eczema, acne and dry, flaky skin can all be partially attributed to the excess cortisol and oil that is produced as a stress response. Hormones, neuropeptides and other signaling molecules also released during these times can be as aging as sunlight because they break down proteins and DNA. All this disruption drives many clients into the bathroom in a quest to somehow fix or “cleanse” the situation.

In turn, picking produces more pimples because of the increased blood flow, flushing, heat, redness as well as spreading bacteria beneath the skin into other areas where it can repeat its dirty work. This is when pickers have a field day.

I recently had a client tell me that she “prepares” her bathroom for a picking session. She brings in a magnifying mirror, comfortable chair and box of Kleenex and then works on her skin for over an hour. She told me it gives her a sense of control, relief, of cleansing and emotional release. It is also the opinion of psychologist Dr. Ted Grossbart, assistant clinical professor of psychology at Harvard Medical School, that the compulsion to pick can be intensified by drugs taken for ADD and ADHD.

“So what can skin care professionals do for the skin of a picker?”

Mind Over Matter

Of course, after the picking and ensuing scabbing, most clients feel shame and even disgust. It is a deeply psychological and complicated process. As estheticians, we are on the frontline of this phenomenon and there are many ways we can help. Ask your client to become aware of when they pick—is it in the car, at her desk at work? What are the triggers?

Our role as skin care professionals is to listen before we start coming up with solutions and recommendations. For this reason, it is important to know mental health professionals who we can confidently refer to when we encounter extreme cases of picking and compulsive behavior. These are not comfortable conversations to have with a client, but in the cases of extreme compulsions, they are necessary ones.

Hypnotherapy has helped free many of my clients from picking urges. Another process called Eye Movement Desensitization and Reprocessing (EMDR), which is an integrative approach to psychotherapy, has been highly recommended to get to the ‘root’ cause of trauma and stress.

According to Jessica McIntyre, M.A.,M.F.T., C.Ht., “EMDR stimulates information that has been stored about a stressful and traumatic situation and allows the brain to reprocess the experience so the patient can move forward.”

Finding a professional in your area who can offer this service to your clients would add another option to treat clients who are persistent pickers.

So what can skincare professionals do for the skin of a picker?

Estheticians to the Rescue

Simply coming for a facial without makeup is a big step for a compulsive skin picker—one that makes them feel uncomfortable and vulnerable at first. Your social skills, tact and TLC come into play here. You’ll notice that teenagers who are struggling with acne rarely make eye contact on their first visit because they are ashamed about how their skin looks. As their skin improves, so does their demeanor. They smile and look at me directly and obviously feel more confident about themselves.

My tips borne from years of experience:

  • First and foremost, create a comfortable and safe environment for the client. As she (or he) becomes more at ease and feels more confident in discussing her problems, you can then prescribe treatments and products that can start the road to recovery. Clients must never feel judged.
  • Customize facials that keep the skin surface smooth with exfoliants and include the use of AHAs, BHAs and light peeling agents that will get rid of the little bumps and unevenness that might tempt those fingers to go to work. Add electrotherapies that work on a deeper level to heal without causing further trauma and make sure the skin is kept properly hydrated.
  • Psychiatrist Iona Ginsburg, M.D., a pioneer in psychodermatology research, has a useful tip. She encourages her patients to put Band-Aids around a couple of key fingers to help check their behavior.
  • If you have a makeup artist on the premises, engage her to show your client the best techniques for applying foundation and concealers to improve the way the skin appears now.
  • Encourage your clients to wash their face by candlelight and time themselves in the bathroom. Keep homecare routines simple and uncomplicated. No more than five minutes to cleanse, tone and moisturize.
  • Tactfully discourage over-washing the skin and using harsh products that exacerbate the problem.
  • To reduce the occurrence of picking in between treatments, particularly for the tempting ‘juicy pimples,’ offer a free 'squeeze' or ‘zap’ to prevent any damage or scarring.
  • Stay in touch and follow up after each treatment. Make sure your client knows you are accessible.
  • Once the picking habit is under control, the real healing can begin—inside and out.

Confucius once said: “True quality of life comes from a lasting harmony between the body and the mind.”

More than that, it affects how we exist in the eyes of others. This is not vanity; it is survival and over the years, has made me realize I am doing something important for those I work on. Helping clients eliminate picking their skin is just one example of the many things we can do. 

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