Developing an Integrated Wearable and Patch System to Address Skin Picking Disorder

Abstract Significance: Skin-picking disorder (SPD), also known as excoriation disorder or dermatillomania, is a debilitating condition affecting approximately 3.5% of the population. It causes significant morbidity, including physical skin damage and profound impacts on quality of life due to shame, distress, and social withdrawal. Although evidence-based behavioral therapies like Habit Reversal Training (HRT) are effective, their utility is limited by high relapse rates, low accessibility, and challenges with adherence. To address these gaps, this Phase I project seeks to adapt an existing wrist-worn gesture detection device (Keen2) and integrate it with a novel proximity-sensing wearable patch to assist in awareness and self-management of SPD. This project builds on HabitAware’s success with a similar system for trichotillomania, which demonstrated feasibility, acceptability, and preliminary efficacy. Hypothesis: A combined proximity-sensing patch and motion-detection wearable system will enhance the ability to detect and interrupt skin-picking behaviors effectively. By increasing awareness of skin-picking behaviors through real-time feedback, the system will support users in engaging in therapeutic strategies like stimulus control and HRT. Specific Aim 1: Optimize the system’s acceptability, utility, and feasibility by conducting 1:1 interviews with 10 expert SPD clinicians and 10 adults with SPD. Feedback will guide refinements to the hardware design, app interface, and system functionality. Final design specifications will be reviewed with the same stakeholders to confirm acceptability and feasibility. Specific Aim 2: We will establish the system’s ability to detect skin-picking behaviors accurately by collecting gesture data from 10 adults with SPD in lab-based video-recorded sessions. This data will inform optimization of the motion-detection algorithm and proximity-sensing parameters. A working prototype of the wrist sensor and patch system will then be tested for accuracy with 10 additional adults with SPD during in-person sessions simulating real-world conditions. We aim to achieve acceptable true positive detection and false positives per hour, consistent with prior HabitAware data. Long-Term Goal: The development of a scalable and effective system for SPD will address a critical public health need, offering an accessible alternative to traditional behavioral therapy. Pending successful completion of this Phase I project, we will pursue a Phase II proposal to further refine the system and test its clinical efficacy in a field-based randomized controlled trial.