 Purpose: Self-injurious skin picking is a problem documented to occur in 2 of dermatology patients Gupta, Gupta and Haberman, 1986 , and approximately 4 of the general population Keuthen et al., 2000. It is widely under recognized, with medical sequelae that can include scarring, infections, lesions, and potentially life-threatening outcomes OSullivan et al., 1999. In a prior study, fluoxetine was shown to be superior to placebo in treating self-injurious skin picking in a modest-sized double blind trial Simeon et al., 1997. Similarly, open-label trials of other SSRIs, including sertraline Kalivas, Kalivas and Gilman, 1996 and fluvoxamine Arnold et al., 1999 resulted in reductions in skin-picking behavior. Escitalopram is a new SSRI that may have superior efficacy for the treatment of major depression and fewer side effects than other SSRIs. This study aims to assess the efficacy of escitalopram in patients who suffer from self-injurious skin-picking. 