Skin picking disorder (SPD) has frequently been reported to start before the age of 10; but "very-early onset" type was not defined before in the literature. Also, research on the treatment of SPD in childhood is limited. We presented a "very-early onset" SPD case whose symptoms have started on the age of 4 and escalated with her comorbid oppositional defiant disorder diagnosis. Patient was successfully treated with low dose (0.25 mg/day) risperidone and proper psychoeducational interventions. Identifying SPD in very early childhood is hard cause; criterion of SPD might not capture all the specific features which very young children manifest and clinicians might overlook their complaints. Efficacy of risperidone might reflect a shared psychopathological etiology between impulse control and SPD, and lead future research on treatment of SPD with atypical anti-psychotics.