For as long as I can remember, my thumbs have been regularly adorned with Band-Aids. Whether heading to the office or out to dinner with friends, I’d pack a bandage in my bag, on stand-by to cover my raw and bleeding skin when my habit of picking (and sometimes biting) the skin around my nail beds would inevitably go too far.

Yes, it was embarrassing and often painful, but I never made any real concerted effort to stop until recently. During my engagement manicure, my nail tech pointed out the reason my thumb nails were growing crooked was because I had traumatized my nail bed to the point of deformity (!!). Somehow, it was the wake-up call I needed to kick the habit after decades of taking all my stress or, sometimes, boredom out on my thumbs.

With my wedding approaching and multiple bridal events on the calendar, I vowed that I wouldn’t need to accessorize my wedding manicure with Band-Aids or discreetly hide my thumbs from photos as I’d trained myself to do.

So, I enlisted the help of two doctors — a psychodermatologist and nail dermatologist — for their expert tips to finally kick the habit.

Nail Skin Picking, Defined

“Generally speaking, nail biting, skin picking, nail cuticle picking are all similar type of disorders belonging to the larger obsessive compulsive spectrum disorders,” explains Dr. Mohammad Jafferany, M.D., a board-certified psychiatrist and professor of psychodermatology at Central Michigan University College of Medicine.

Similar to dermatillomania, or skin picking disorder, nail picking is officially known as onychotillomania and is categorized as a body-focused repetitive behavior (BFRB) disorder, says Jafferany, who has combined training in dermatology and psychiatry and specializes in treating disorders like skin picking.

But while mild nail picking is relatively common in the general population, only a small percentage experience considerable psychological distress from nail picking, which is when it crosses over into a disorder, says Dr. Dana Stern, M.D., an assistant clinical professor of dermatology at the Mount Sinai Medical Center in New York City and the only board-certified dermatologist in the country who devotes her entire practice to the diagnosis and treatment of the nail.

Both experts agree that onychotillomania is likely underrecognized and underreported. That’s because it’s not uniformly recognized as a diagnosis in the medical literature and is often studied alongside nail biting, Jafferany says. Plus, there’s the embarrassment and shame factor. “People don't want to bring it up, talk about it, deal with it,” Stern adds.

But a near-constant skin picking habit like mine can come along with not just psychological distress but also side effects including pain and infection, as well as what’s known as post-inflammatory hyper- or hypopigmentation (darkening or lightening of the skin surrounding the nail) and permanent nail dystrophy (abnormal growth of the nail due to damage to the matrix), Stern says.

Why We Pick

Getting a gel manicure has been a part of my regular routine since I was a preteen whose mom was desperate for ways to get her to stop biting her nails. But because I hadn’t addressed any of the root causes, the habit was quickly replaced by picking and biting the skin around my nail beds instead.

Jafferany says a wide range of factors could be behind the habit: Stress and anxiety are common denominators and skin picking is also associated with obsessive-compulsive disorder (or obsessive compulsive tendencies). In addition to OCD, in some cases, there could be another underlying mental health condition at play, like depression, phobia, or even a delusional disorder, Stern says.

However, nail skin picking isn’t always related to an underlying psychiatric disorder. Sometimes, it’s simply the result of boredom or inactivity (for me, this is often while waiting in line at Whole Foods) or a way to seek sensory stimulation, Jafferany shares.

Having family members who also pick or bite is common, which could be the result of genetics and/or simply imitating a parent or sibling who picks, Stern says. (“I’m not biting!” or “You do it, too!" were common retorts in my nail-biting household growing up when someone was called out for having their hands in their mouth.)

Another cause that both experts point to: Perfectionism. In fact, it’s why (in addition to opening you up for a risk of infection) Stern recommends nail pickers stay away from the controversial Russian manicure. “Russian manicures place too much of an emphasis on obsessively perfecting the nail which is often part of the problem for patients who suffer with onychotillomania,” she explains.

How To Stop Skin Picking

Simply put, breaking any bad habit, like smoking or eating too much sugar, is difficult, Stern says. But while you might feel like you’re doomed to be a picker forever, if you’re reading this, you’re already on the right path: “The first step is awareness of the issue and a desire to stop,” Stern says.

She adds that if the behavior is interfering with your social functioning and daily life, it’s time to see a dermatologist (or a psychodermatologist) who can come up with a personalized treatment plan for you, potentially in collaboration with a cognitive behavioral therapist, she says.

So, the million-dollar question: Is it possible to completely kick the habit? Jafferany says yes, but with the caveat that — like other body-focused repetitive behavior disorders (BFRBDs) under the obsessive-compulsive spectrum — it really depends on your individual situation and the root cause. “Many patients get rid of this habit in just a few months…while others may continue on and off for several years,” he says.

In addition to cognitive behavioral therapy, habit reversal therapy (HRT) is considered the standard and first-line approach for treating a variety of BFRBDs, including nail skin picking.

Here’s how to put it into action — and how I fared implementing these expert tips into my own routine.

Step one: Make sure you’re actually aware of your habits and urges. “Typically, most of my patients know why they’re doing it — they can say, ‘It happens when I’m anxious, or when I’m bored sitting in traffic — that’s pretty common,” Stern says. Jafferany also suggests bringing the habit into consciousness by writing a daily diary of your feelings and triggers that produce the urge to pick.

To put his advice in action, I started using the State of Mind feature on my iPhone and Apple Watch, which allows you to log in-the-moment emotions and your overall mood for the day. While not a perfect science, it helped me to pinpoint certain situations, activities, or times of the day when I was most anxious, stressed, or worried — and prone to pick.

Step Two

Find a distracting competing response, like fist clenching, clapping, or sitting on your hands when you have the urge to pick, Jafferany says. Stern also suggests using a stress ball, fidget cube or spinner, or rubber band. “Typically I recommend a loose, bright colored rubber band that you wear around your wrist. It serves as a visual reminder so that when you look down and you're about to pick or bite you see it — and then it's something you can kind of play with in lieu of the habit,” she says.

It seemed too simple to be effective, but with my rubber band secured from my junk drawer I found that anytime I went to mindlessly pick while on a Zoom call, waiting in line, or simply out for drinks for friends looking for sensory stimulation, I’d instead play with the rubber band.

Step Three

The third step is “stimulus control,” AKA steps you take to reduce outside triggers — such as splintered cuticles or cues such as stress, idleness, or overstimulation — to make nail biting or picking physically difficult, Jafferany explains. That might be preventative nail filing and trimming, or going to get a manicure if that motivates you to preserve it, he says. If you’re like me, and a gel manicure doesn’t help with picking or biting the skin around your nails, gloves or bandages around the fingers can be useful physical barriers to make picking more difficult, he says.

I’d already been employing the bandage method with some success to keep myself from being able to pick, but reducing triggers like stress and idleness proved a bit harder with a wedding to plan. My answer: The Class, a seriously cathartic “somatic workout” focused on the mind-body connection. In years past, I thought it was all too woo-woo for me, but as it turns out, allowing myself to make guttural noises and jump, dance, and flail my arms around during freestyle dance sections of the workout was exactly the stress release I needed. Another bonus: It helped me manage the perfectionism at the root of my picking. During The Class, you’re often encouraged to keep your eyes closed, allowing you to move your body without worrying about how it looks in the mirror, or what your neighbor is doing.

Step Four

Social support is key, Jafferany says, so it can be helpful to find the equivalent of a workout buddy to keep you accountable. Whether it’s a family member or friend, this is someone who can “regularly remind you to stop picking and encourage the use of a competing response,” Jafferany says.

For me, that looked like exchanging encouraging texts with my best friend — a fellow thumb picker who wears fake thumbnails who I know won’t ever judge me. Other times, it’s my fiancé holding my hand on the couch when he notices I’ve started picking due to stress while watching House of the Dragon (or, let’s be real, from boredom during a baseball game).

My New At-Home Nail care Routine

After realizing Russian manicures were only feeding into the attainable idea that my nails should be perfectly smooth at all times, I set out to establish an at-home nail routine. The goal: Remove outside triggers, like dry skin, and give the skin around my nails and on my hands the same attention as the skin on my face.

First, I stopped using metal cuticle clippers based on Stern’s advice — my go-to for years for smoothing out uneven skin on my thumbs. Not only do they “overly remove skin and the cuticle,” she says, but they also feed into that never-ending cycle for perfection. (My only nail tool now is a glass nail file, a gentler way to keep nail edges clean, smooth and free from peeling and splits, Stern says.

Then, I focused on hydration. “When the cuticle dries out (from excessive hand washing, hand sanitizer, swimming in chlorine for example), the cuticle can separate and peel and a hangnail can form more easily. These detached segments of cuticle are also often a stimulus for biting and picking,” Stern explains. That’s why prevention, with hydrating products that are effective for the skin around the nail is the best solution, she says. I started keeping Stern’s Nourishing Cuticle Oil on me at all times so I can apply the mess-free rollerball formula — which contains anti-inflammatory and barrier boosting properties — whenever I feel myself picking at the dry and uneven skin around my nails.

I’ve also started incorporating a fancy hand cream from Soft Services — a nourishing and restoring formula with retinol, colloidal oatmeal, and panthenol — into my nighttime routine, to hydrate the cuticles and prevents hangnails (and me from picking them). Plus, my hands now look and feel soft at all times.

While I can’t say my habit is completely behind me, I’ve been less reliant on emergency Band-Aids than ever. And when I think about those close-up hand photos on my wedding day, I’m no longer panicked — a huge victory for a lifelong picker.