Context • Excoriation (skin picking) disorder is characterized by the need or 
urge to pick, scratch, pinch, touch, rub, scrub, squeeze, bite, or dig the skin, 
and it can be a perplexing condition for the inexperienced physician. Treatments 
include pharmacotherapy, psychotherapy, and alternative therapies. Alternative 
therapies for excoriation disorder and other body-focused repetitive behaviors 
include yoga, aerobic exercise, acupuncture, biofeedback, hypnosis, and inositol 
and N-acetylcysteine, among others. Objective • This review article intended to 
review the current literature on the alternative therapies to provide a brief 
update on their benefits for the treatment of excoriation disorder for use in 
conjunction with psychotherapy and pharmacotherapy in the management of a 
challenging group of patients. Design • This review (focusing on literature 
published in the last 15 y, selected from a search of PubMed) critically 
considers the evidence for the use of alternative therapies in the treatment of 
excoriation disorder. Setting • This review was conducted at the National 
University of Asunción (San Lorenzo, Paraguay). Results • Results for yoga were 
as follows: This technique may influence the structure and functioning of the 
areas of emotional processing involved in the pathophysiology of excoriation 
disorder and other body-focused repetitive behaviors, such as trichotillomania. 
Although still limited, the current research team's use of yoga as a treatment 
has given useful results. Results for aerobic exercise were as follows: People 
suffering from excoriation disorder and other-body focused repetitive behaviors 
generally have a worsening of their behaviors in times of negative mood and 
anxiety. As exercise has qualities that allow individuals to improve their mood 
and reduce their anxiety, it is likely that it also can help reduce behaviors 
like hair pulling or scratching, and it should be considered to be an adjunctive 
therapy. Results for acupuncture were as follows: The mechanism of action of 
acupuncture increases serotonergic activity and releases endorphins in the 
hypothalamus and limbic region, which could be beneficial in patients with 
trichotillomania and excoriation disorder. Results for biofeedback were as 
follows: Several case reports have suggested the value of biofeedback in 
reducing tics, which bear some psychophysiological similarities to body-focused 
repetitive behaviors, such as trichotillomania and excoriation disorder. Results 
for hypnosis were as follows: When used as a channel for other types of 
interventions, such as psychotherapy, hypnosis can help counteract the stress 
that triggers the picking behaviors in some patients. Results for inositol and 
N-acetylcysteine were as follows: Although more research is needed, these are 
promising drugs that may be helpful in reducing the picking behavior. 
Conclusions • The review indicates that yoga, aerobic exercise, acupuncture, 
biofeedback, hypnosis, and inositol and N-acetylcysteine all show promise in the 
treatment of excoriation disorder and other body-focused repetitive behaviors, 
such as trichotillomania. In the current research team's experience, mainly yoga 
and aerobic exercise have been shown useful in combination with psychotherapy 
and pharmacotherapy. Obtaining solid evidence about the long-term beneficial 
effects of these alternative therapies for the treatment of excoriation disorder 
requires more investigation.