NAC for Skin Picking: Four Trial Checks

If you cannot stop picking, have cuts that do not heal within days, or picking disrupts daily life, NHS¹ guidance advises a medical appointment. A clinician can assess both the behavior and skin conditions such as acne or eczema that may trigger it.¹

Who entered

A 2016 trial randomized 66 adults with excoriation disorder to N-acetylcysteine (NAC), 1,200–3,000 mg daily, or placebo for 12 weeks. Eligible ages were 18–65; asthma and pregnancy were excluded.²

Symptom score

The primary analysis used 0–40 NE-YBOCS picking-severity scores (lower is better) from 60 participants with follow-up data, without filling missing visits. Scores favored NAC over time (P = .048); week-12 means were 11.5 versus 14.1, NAC versus placebo.²

Who finished

32/35 versus 21/31 completed treatment. Among completers, 15/32 versus 4/21 were rated much or very much improved. Unequal dropout limits that comparison. Functioning did not improve significantly more.²

Harms and care

Nausea affected 5/35 versus 1/31. Twelve weeks cannot establish long-term safety. Great American Health supplied NAC; authors disclosed industry relationships.²

A NAC bottle labeled as a dietary supplement is not evidence of FDA³ approval for treating skin picking. The agency’s NAC policy addresses enforcement discretion for certain products; it excludes products marketed to treat disease. That policy is not a treatment recommendation.³

Before taking a supplement, have a clinician or pharmacist check the product, other medicines and supplements, and planned surgery. The FDA⁴ warns that supplements can interact with medicines and interfere with laboratory tests or surgery. If a supplement causes a bad reaction, stop it and seek medical advice.⁴

Ask about CBT with habit reversal training. NHS¹ guidance describes recognizing picking triggers and replacing picking with a less harmful behavior. It also advises keeping skin clean and obtaining specialist assessment when skin is badly damaged or an underlying skin condition needs treatment.¹

“Describe It Before You Sort It” in Skin, Head to Toe organizes location, appearance and sensation, speed of change, and other body changes. For this appointment, add where you pick, any bleeding or wounds, and what you have tried to help yourself stop.