Wednesday, October 31, 2007

Picky, Picky

It’s been a while since I’ve done an advice post. So, inspired by a few inquiries from friends, I bring you the following public service post.

Are you a face picker? Are you obsessed with removing every little imperfection in your complexion? Do you spend a half hour at a time sequestered in the bathroom, up against the mirror, scanning every inch of your skin, imagining defects if you can’t actually see them? Do you inevitably make things worse, leaving yourself with an angry bleeding crater where there was nothing before but a slightly tender little bump? Do you promise yourself you’ll never do this again, only to be back at it the very next day?

I’m here to help.

I’ve known a lot of you. Under times of stress, I’ve joined your ranks. I’ve see many patients, almost always young women, with the telltale red marks fanning out across their cheeks. It’s never their reason for the doctor visit, and I know how painful it is for them when I bring it up, uncovering their shame. But there are things that can help you, if not stop, at least minimize the carnage.

Rules to Pick By
  • Don’t think you’ll be able to stop through willpower alone. Habits like this—nail biting, hair twirling, face picking—are notoriously hard to break that way, at least in the long term. You need a strategy.
  • The simplest trick of all, yet the one that is most resisted: Wherever it is that you’re doing it, switch the light bulb for one of exceedingly low wattage. When you can’t see the “problems,” one of the triggers is gone. Stop arguing about this one. Just try it. You can always switch the stupid bulbs back again.
  • Get a face care regimen, and stick with it. It doesn’t really matter much which one. Most of them are based on one of four ingredients: benzoyl peroxide, retinoids, antibiotics, or salicylic acid. Some are over the counter, some are prescription. They all work ok, but none of them work overnight. You need to give a product at least a month to see if it agrees with you. (This is probably why the Pr0@ctiv system is successful. Although it’s just benzoyl peroxide, it gets you to buy into the regular use for a month thing. You can get similar “systems” for much less at the drugstore.)
  • Consider investing in one of those electric pimple-zappers. These are pricey, but can be worth it. They ostensibly work by heating the blemish, and are meant to be used on the deep painful kind of blemish. This may or may not be effective at curing the pimple, but is definitely effective at hurting like hell. This is psychologically quite useful, because it gives you something serious to do. Take that! You can think as you hear the zap and feel the pain. If you can transfer your compulsion from picking—which is especially counterproductive with this kind of pimple—to zapping, you may be able to short-circuit the impulse to try and “fix” it by squeezing.
  • When a pimple is healing—whether you picked at it or not—it usually flakes. Do NOT pick at these flakes with your filthy fingernails. Get a flat-tipped tweezer, and remove the dead skin with those. And don’t peel the skin back—pull forward, to pull off just the dead part. Scraping at the skin with your fingernails will grind bacteria in, and then you’ll get all sorts of nastiness.
  • In fact, never scrape at your skin with your fingernails ever. If you end up with a blemish that MUST be manually removed—you know the ones I’m talking about, the kind that you avert your eyes from if you spot one on a stranger and wonder how on earth their loved one let them leave the house like that—do NOT pick at it with your fingernails. Use a washcloth, a cotton pad, almost anything but your fingernails.
  • If you should end up with something on your face that is bleeding—which should only happen if you’ve ignored one or more of the instructions above, but whatever—I have a neat trick for stopping the bleeding in time for you to get to work. Remember how I said you should never use decongestant nasal spray for decongesting, but you can use it for a nosebleed? Well, you can also use it for other kinds of bleeding. A few drops on a bleeding wound constricts the blood vessels and stops the hemorrhage.
  • Never use antibiotic ointments on any wound, but especially not on the face. About a third of folks who use these for any length of time develop a contact allergy to them, and the result looks just like an infection. So you keep putting the ointment on, and make the allergy worse, and put even more on, etc. … plain Vaseline is good for wounds, but use sparingly on your face, since if you spread it around, it’ll make you break out more. A tiny dab will help keep a lesion from looking quite so crusty.
  • When you need camouflage, Dermablend is amazing stuff. Unfortunately it’s almost impossible to figure out which shade is best for you on line, which really sucks. If you can find a store that sells it, that’s probably the best way to find out, but I’ve never had the guts to approach one of those white-coated cosmetics ladies at the department stores myself. I’m not sure what I’m afraid of, but it has something to do with the thought of someone peering at my skin under bright lights and then gasping in horror. My skin is ok, but they’re paid to make you think your skin is only fit for a freak show.
  • Try to remember that the vast majority of blemishes do not contain anything that has to come out. Yes, there is the odd whitehead or blackhead that can be easily removed, and very rarely an exceedingly ripe pustule that can be released, but most of the time, thinking that there’s something there that you can get out and thereby fix the problem is the path to madness, and to the wreck of a perfectly nice complexion.

41 comments:

Finding My New Normal said...

Interesting timing. I had a cold this week and in the ensuing noseblowing, my nose and nostrils are left a sore, scabby, crusty, chapped mess. Would vaseline work on that? I'm desprate.

rlbates said...

Aquafor is even better than vaseline for scraps, minor burns, etc. For the sore 'inner' nose use Ayr nasal spray or gel.

Sorry I disagree with you on the antibiotic ointment. The only one I know that routinely causes an "allergic" type reaction is Neosporin. I usually recommend and use Bacitracin or Bactrin or clear Betadine ointment.

Shirky said...

awesome if a bit gross post. I am a total zit-worrier. I used to not get them but now I get a lot. They are so painful too. I am so tempted to try to kill them through brute squeezing force just to make them stop hurting!

Anonymous said...

Ahhh, all very good for obsessive face pickers. Except this reader is a scalp picker. (At least I'm not the eyebrow/eyelash puller-outer.) The number of scabs is directly proportional to the inverse of how busy I am at work. (whatever that means...) Anxiety expressed through scalp picking. Since it's not a matter of wattage (in the lighting department) but a matter of tactile discovery and fingernail length, the only cure is busyness at work. :) Oh well.

valleygirl said...

Interesting post. I am a total zit picker, but fortunately, I don't get too many to worry about. Never knew that about the antibiotic ointment - learned something new!

clara-runner said...

Hey- were you in my bathroom yesterday? I swear you are speaking directly to me. I am a picker.

Thanks for the great advice!

ozma said...

I needed this advice when I was 13.

It's way too late now. Irony is my skins has been gorgeous but scarred for a long time. The day I moved out of my parent's house was the day I had flawless skin. Except for the scars. It's too bad but they are very hard to see. Still, I did need this advice. Where were you when I was 13? (You were 14 probably.)

Anonymous said...

What about those of us who are not just face pickers? I can't seem to stop, and I even have tiny scars on my shoulders and legs. I've done this sine I was about 10, well before acne. It's an awful shameful secret. I am an otherwise high-functioning woman, though somewhat prone to anxiety, and I'm terribly embarrassed by this. I CAN'T stop though - I've really, really tried. It relaxes me somehow. I work in a hospital, and I'm really worried about bringing home MSRA. I'll try your suggestions, but I still feel kind of hopeless about it all.

Anonymous said...

Yesterday when I read this I was wondering why on earth it didn't apply to me. My skincare regime consists of cleanser morning and night and I wear no make-up and yet I have no need to pick...then I had another look and it says "young women". Ha - an advantage of being AMA then! Wrinkles rock!

Fiona

Katie W said...

Not a face picker, but very definitely a finger picker. It's rare that I'll not have tender patches round my fingers. My hobby probably doesn't help as climbing tends to dry your hands out!
I find I do it when I'm bored, so at the moment lots of it goes on in lectures, I can now even do it without looking!
I'm hoping that once I actually start teaching I won't have those 30 minutes thumb twidling spells.

Anonymous said...

Wait, so you're saying that the way that I pick at my face, pick at my scalp, AND pull out my eyebrows isn't healthy?

Anonymous said...

now tell me WHY I get them please

Anonymous said...

um yeah, i am sitting here with a scab on my chin, so post appreciated.

dara said...

Really? I have to stop using Neosporin on my zits? I've found that just a tiny dab, and the zit is gone in 2-3 days.
Now what? Neosporin stopped me from pickin'.

shit-house-mouse.

Anonymous said...

I am printing this out and posting it next to my bathroom mirror. Too bad I won't be able to read it because the light bulbs will be too dim! :) Thank you.

Anonymous said...

This was a fabulous post, and very topical for me. (My skin is beautiful now because i'm ovulating... not so much in about 10 days.)

If only i could find a cure for the ugly bumps and redness on my upper arms. I was told that it would go away when i hit 30. I was lied to.

amy said...

Uhhh... you just made my heart come to a complete stop. Skin picking is an OCD, isn't it? I can't get myself to stop picking my pimples (it's not just my face; it's my shoulders and my legs too)... cry...

Anonymous said...

Remember the movie 'My Big Fat Greek Wedding'? The father of the bride used Windex for every skin problem. I've actually tried Windex on pimples and it works really well. Dries them up in record time. Apparently there is a product used in Greece for skin problems whose 'active' ingredient is ammonia.

PA said...

Wow - this post made me stop in my tracks. I am completely embarrassed about this. Neither my mother (when I was a teen) nor my husband have been successful in helping (making) me stop. It is awful. Now I have scars on my face. Proactive is the only thing that seems to help. I think I could quit if I could get rid of the scars. I tried microderm abraision but no luck. Any suggestions? I would just love to get rid of these scars. They are such vivid reminders of a painful secret.

Wendy said...

Why shouldn't we use antibiotic ointment on any wound? I wouldn't use it on my face, but I've used it on my hands and other places.
Curious.

another ashamed compulsive picker said...

Please help me! I am terrible about this, but like earlier posters above, it is more of a tactile thing than a visual thing. I pick at all scabs, pimples, hangnails etc. Anything rough on my skin, I compulsively must get rid of. The rough bits drive me CRAZY once I know they are there. Even if it looks uglier when I am done, at least it feels smooth. What can I do? I've been trying to stop for ages to no avail.

Please help.

Jessie said...

I tried a bunch of those skin care systems, and stuck with them all for a month. None of them worked. :/

Oh well.

Anonymous said...

hey i'm an ex-face picker and i think your advice is good, but doesn't get to the root of the problem, which as somebody mentioned is more OCD than aesthetic. i did it (still do, once in a blue moon) when i was stressed, bored, depressed, or just down for a little self-contemplation and/or guilt. even though i rationally knew it definitely made my skin worse, not better. i think it's a control issue - even if i can't get my problems out just as easily, somehow that satisfying feeling of getting the bad things out of me is a suitable stand-in.

anyway, how did i get over it? this is not very helpful i realize, or maybe it is, but i just grew out of it without really trying to. i stopped obsessing over being obsessed with it. i stopped feeling guilty and ashamed and thinking of it as some terrible secret. (i still let myself do it every so often, if i feel like it, which isn't as often as i imagined.) i started joking/commiserating about it with people i know who pick their lips, or their scalp, or their feet (i have worked with all of these so it's not as uncommon as you think.)

anyway, thanks for the doctorly and motherly advice, and much love. good luck to all you souls out there for whom this is a big problem. it's not a life sentence.

Anonymous said...

Okay...if we are confessing dark obsessive habits, how about cheek/inside of mouth biting?

I know it's gross. I bite off little pieces of the surface layer of the skin inside my mouth. I used to bite my nails, and I managed to quit doing that, but I substituted mouth biting instead. I don't do it in public, but usually when I'm reading, or on the computer, or driving. I almost don't know I'm doing.

I honestly don't care and I don't think others notice...but the only thing that worries me is that somehow I'm setting myself up for mouth cancer or something. Like, the cells have to keep repairing themselves and growing back almost every day, so sometime, I'm just going to get a big old hyperplasia in there.

Anyone? will I give myself mouth cancer? Does ANYONE else do this?

Anonymous said...

Uh, this may be weird (and gross) -- probably more of a shameful secret than even face picking -- but I find that my skin AND hair look better & better the less I wash them.

I know, I know! Sounds totally disgusting, doesn't it? Yet all my blackheads cleared up in a few weeks once I stopped cleansing / washing / using toner or astringent. And my once lifeless, dull, limp, frizzy hair is now buoyant, shiny, luxurious, and thick with more body than I know what to do with.

I wash my hair 2x/week and my face 1x/week. I use vaseline to remove makeup; I completely avoid soap and water on my face except for the 1x/weekly wash.

I've since developed the suspicion that the more you use drugstore products on your skin and hair, the more you NEED to use them. No one ever advises you to take a break from these things entirely because there's no money in it.

I found that the more I used those products, the worse my skin looked. Nicholas Perricone, Pro Activ, anything with salicylic acid -- my face just looked more and more like a lunar landscape, so rough and cratered I couldn't even use makeup. Now I have smooth clear dewy youthful (dirty) skin with no embarrassing redness. My pores are even smaller -- and every dermatologist told me, "There's nothing we can do about those big pores."

I think that not washing my skin means it's better hydrated and plumper, causing it to be smoother. I'm just guessing, though.

Anonymous said...

Who gives a shit about a "nice complexion"? Picking is fun.

Sorry, "who gives a shit" is trollish. Um... thank you very much for sharing this advice with those who might be interested. However, the thing that jumped out at me was the part about bringing this up with patients. I would encourage you to keep in mind that your patients might not be so much "shamed" as "surprised and annoyed that you consider this an appropriate *medical* topic, perhaps to be next followed by an admonishment that that shirt really needs ironing". I don't think there's anything wrong with the exchange of cosmetic tips amongst people into that sort of thing, just with their elevation to some sort of general advice.

Jessie said...

I kind of agree with that actually. I pick at my face sometimes, but not compulsively. I just like popping out the shit that's in my pores. ;)

Obviously there are a lot of people who are happy to get this advice though.

I'd be kind of chagrined if my doctor brought up my acne, because while I am certainly aware of it (and who isn't, seriously) I have deliberately chosen NOT to see medical care for it, for a variety of reasons that I would rather not discuss with my doctor (but am willing to elaborate on if anyone is curious).

I prefer my doctor to trust me to make appropriate decisions and to ask for medical help when I need/want it. Some doctors are comfortable with this approach, and some aren't. One thing I like about having insurance and thus being able to have a primary care provider (as opposed to heading to the clinic or planned parenthood for all my needs) is that they seem to be more willing to accept my opinion on things. (e.g. they don't try to convince me that I need to get gardisil because my partner might be cheating on me.) It's an interesting phenomenon.

Eve said...

I am a TOTAL picker - with my face, it is not so bad (good tips though), but I pick my cuticles until they bleed - especially while I am in meetings or bored/in a busy stupor at work. The only thing that helps is keeping the clippers at work to remove the bits I would pick and keeping thick hand lotion at my desk to keep everything moisturized.

My husband tells me not to pick, but I would love to pick his face, too. It could be like monkeys grooming each other. ;-)

Anonymous said...

OMG, do you stalk me or something?? you just described me to a tee. so shameful. i think instead of hair pulling (trichotillomania) i have compulsive face picking. maybe you can name the new disorder and become really famouse.

Amber said...

I'm a compulsive scalp picker, and have been since I was in elementary school (nearly 30 years). For me, it's another expression of my lifelong OCDish tendencies that have manifested in other ways (repeated tooth brushing & hand-washing, cleaning, very specific ways of ordering items in my home). The condition of my scalp is inversely related to the level of stress and/or anxiety in my life, and there are times when I absolutely cannot calm my brain without doing it. However, I have found that using sulfur soap and shampoo help in that it keeps my scalp smooth and less amenable to picking (it has also made my facial skin very smooth and usually clear, and has helped with the cracked skin on my hands and feet). I also try to redirect that impulse when I feel it to other activities (chewing a very strong minty gum, or doing an extra workout, etc.). If I do it subconsciously, my husband will remind me to stop. My sister also picks her scalp when she's stressed/anxious.

Thanks for the skincare advice from a medical standpoint. I love getting more information. I find a lot of helpful information on skincare on makeupalley.com.

Old MD Girl said...

Whoever said that less is more regarding face care is a genius. Anything with salicylic acid gives me boils and a rash. And also anything with perfume in it. Unfortunately, I am very oily and live in a polluted city and hence collect smog on my skin as I walk to school, so I have to wash every day. But yeah. The same goes for not washing the hair.

I also admit that I like squeezing my blackheads and pimples. But I don't think I am compulsive about it, and well.... the blackheads never seem to go away otherwise. And I don't have any scars from it. Yet.

What I really need is advice on how to stop the hair twirling.

Anonymous said...

I can control these behaviors (picking of fingers, lips, blemishes, scalp) if I avoid caffeine. Any amount of caffeine, including small amounts of chocolate, and I have no control. I often don't even realize I'm doing it until it is too late and I've created a wound.

Appreciate all the good information in this post. Thank you.

Anonymous said...

DM, I wonder, could you tell me the name of the post where you described what you'd like to see when interviewing students for med school? I'm admin for a board for senior school students in Scotland and a whole bunch of them are in the initial interview stages. I thought I could copy and paste some of your info for them.

For instance, one guy has been told that they will ask him about:

Independent thought and motivation
Expectation of and enthusiasm of a medical career
Understanding of current issues
The Glasgow Curriculum (they're very into student based learning)
Communication skills

Thanks

Fiona

Anonymous said...

Doctor Mama are you okay? We haven't heard from you and I for one miss your seeing new posts from you.

Anonymous said...

"Anonymous said...
Okay...if we are confessing dark obsessive habits, how about cheek/inside of mouth biting?"

YES and i also used to bite my nails. have managed to put an end to most of these strange (and damaging!) habits recently though. i find that if you've always got a pen or something to gnaw on (why am i admitting to this) it takes your mind off it. however the whole "face picking" issue is one i'm still working on..slowly ruining pores atm:(

Steph said...

Doctor Mama,
Where, oh where are you? I've just become severely addicted to your blog and now you've become scarce? Come back!

Mignon said...

I'm also surprised about the 'no antibiotic use' bit. Really - on nothing? I worry about my kids with scrapes on the their knees and cuts on their hands when they play on public play structures, you know?

Also, I'm not a picker but a nail biter. However, I see this as purely functional behavior. The sound of nails being clipped gives me the willies, and I'm much better at shaping them and keeping them trimmed with my teeth. So.

Heather said...

Can I ask you about kids that are pickers? My five year old will pick at things until they bleed and then they don't go away for months because she does NOT leave them alone. At one point this month she had FOUR different pick zones - two on her face, one on her knee and one on her torso. They've all cleared up except the mouth one - I think it started as a tiny crack in the corner of her mouth and now it looks like a giant coldsore. AGGHH! We have tried every sort of psychological tactic, as well as giving her creams and lip balms to take with her to school. I'm so concerned that she will end up scarred and if we don't get a handle on this habit soon she could stand to be much worse as a teenager when the acne arrives.

Anonymous said...

Thank you for this. :o)

Shayna said...

I've had a compulsive skin piking problem since I was a child. Most of the damage is on my legs.. I thought I'd gotten past the picking over the past couple years (I'm 20 now), and most of my scars are very faint.. but this past winter (I live in Florida) we had a bad flea problem in my house and I picked my legs really bad. It's summer now and I can't wear shorts or a bathing suit because my legs look so horrible.. is there anything I can do to help with the scarring?

Anonymous said...

The little bumps and redness on the backs of arms (sometimes on the butt and upper thighs too) can be stopped by exfoliating and moisturizing often. For some reason, some people have places where the skin does not shed as it should and the hairs get ingrown and little red bumps are created in those places. This is only for arms and such, not the face...loofah, or some other thing...in just those spots...and then moisturize...it almost completely gets rid of those red bumps.