What are the other Names for this Condition? (Also known as/Synonyms)

• Compulsive Skin Picking Acne Disorder
• Excoriated Acne
• Picker’s Acne

What is Acne Excoriée? (Definition/Background Information)

• Acne is a common skin condition that causes inflamed, red spots/lesions to appear on the face, neck, shoulders, and other regions. The condition occurs when the tiny pilosebaceous follicles become clogged with dead cells and oil
• Acne Excoriée develops when the acne lesions are subjected to physical trauma, such as picking or scratching, which may result in infection and severe scarring. The condition is also referred to as Picker’s Acne
• Acne Excoriée may be termed as an aggravated form of acne; the term ‘excoriated’ is used to describe the removal/damage of skin by picking, scratching, or scraping
• It is mostly observed in individuals obsessed with eliminating their pimples by picking. This practice of ‘acne skin picking’ has been  said to be seen more in females, both young and older. It is also seen in males.
• Depending on the severity of the condition, Acne Excoriée may be treated with the use of creams and gels, skin surgery, and even laser therapy
• If there is an underlying psychiatric condition, such as anxiety or depression, then suitable therapy (counseling and medications) may be necessary to treat the same
• The prognosis of Acne Excoriée is generally excellent with adequate treatment, although severe forms of the condition may result in extensive skin scarring and cosmetic disfigurement requiring more intensive treatment

Who gets Acne Excoriée? (Age and Sex Distribution)

• Acne Excoriée may be seen in a wide age range of individuals affecting both children and adults (majority of the cases)
• Both males and females are affected, but the condition is more common in females
• There is no racial or ethnic predilection

What are the Risk Factors for Acne Excoriée? (Predisposing Factors)

Acne Excoriée is a condition that is described in those with acne. The risk factors for developing the condition include:

• Women, both when young and those who develop acne later in life (late-onset acne)
• Individuals with anxiety disorders, depression, severe stress, etc.
• Body dysmorphic disorder
• Obsessive compulsive disorder
• Those with other ‘nervous’ disorders
• Some individuals may be habituated to pick on their skin
• Any individual with acne may be at risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acne Excoriée? (Etiology)

Acne Excoriée is caused by scratching, picking, or squeezing the lesions that form on the skin as a result of acne. It leads to superficial bleeding, oozing of pus, or even deep scarring of the skin.

• All forms of acne lesions are susceptible to Acne Excoriée - closed comedones, open comedones, papules, and pustules
• Some individuals with emotional or psychological issues are more prone to subjecting the acne pimples to physical trauma (by picking on them). There may be an uncontrollable urge or compulsion to pick on the skin
• This may occur in some individuals who may be obsessed with their physical appearance, causing them to pick on even minor acne lesions. This results in a paradoxical exacerbation of the spectrum of acne problems
• The skin may be picked at with the finger nails, or pins, or other instruments. The picking or scratching may be triggered by the appearance of the pimple or a minor itching sensation

What are the Signs and Symptoms of Acne Excoriée?

The signs and symptoms of Acne Excoriée are as follows:

• Mild to severely disfigured acne skin
• Bleeding and oozing of acne skin lesions
• Development of secondary bacterial or fungal infections
• Permanent pitting and scarring of the skin may occur later in the condition
• The face, neck, shoulders, and arms, sites that are easily accessible or within reach are normally affected
• Signs and symptoms of the underlying nervous disorder
• Severe emotional distress and embarrassment

Sometimes due to excoriation, the individual may have scar tissue, but no findings of underlying acne.

How is Acne Excoriée Diagnosed?

• Acne Excoriée may be diagnosed through a simple physical examination by the physician or dermatologist
• The healthcare provider may also ask many questions related to the individual’s age, family medical history, current medications, cosmetics, body lotions used, other medical/psychiatric conditions, etc.
• Psychological assessment of the affected individual
• If secondary infections develop, then a bacterial or yeast culture may be done
• Invasive methods, such as skin biopsy, are typically not required; a diagnosis can be made through a physical examination itself

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acne Excoriée?

Some of the complications of Acne Excoriée include:

• Cosmetic disfigurement and permanent scarring - cosmetic surgery may be required to remove such scars and marks in some cases
• Increased psychological stress, which can affect one’s educational or work performance, or their personal relationships

How is Acne Excoriée Treated?

The treatment measures for Acne Excoriée are dependent upon the severity of the skin condition. These measures are outlined below:

• Treatment of the underlying psychological disorder through suitable medication and counseling (psychotherapy)
• Use of antiseptic, antibiotic topical applications, anti-inflammatory gels, lotions, and creams. Benzoyl peroxide is the most common ointment for milder forms of acne, and topical retinoids are used for regulating hair follicles. Topical retinoids help treat acne by removing the follicular plugs from the affected region
• Medications, such as antibiotics, oral retinoids, and hormones (such as oral contraceptives or antiandrogens for women), are used for more moderate cases
• In case of severe acne, isotretinoin is prescribed (though NOT for pregnant women). However, there may be some adverse side effects for this drug, and therefore, the patient needs to be closely monitored

Note: Isotretinoin should NOT be used on pregnant women or on women who are planning to become pregnant. This is very important because isotretinoin can cause fetal abnormalities and malformations during the growth of the fetus in the mother’s womb, termed teratogenic defects of isotretinoin. Hence, a pregnancy test is usually performed in women of child-bearing age before starting treatment with isotretinoin.

• Microneedling or microneedling with radiofrequency can remodel the skin surface when the defects are not too severe
• Under local anesthesia, a cosmetic procedure called dermabrasion is performed. In this procedure, the raised lumpy acne scars and skin are abraded
• Other cosmetic procedures, such as chemical peeling, minor skin surgery (punch excision), and microdermabrasion, may be used
• Lasers may be used for various levels of intensity of skin resurfacing

How can Acne Excoriée be Prevented?

• Acne Excoriée occurs due to various psychological factors/conditions in individuals with acne. It may not be preventable in many cases
• Adequate treatment of mental health conditions, such as anxiety disorder, body dysmorphic disorder, or obsessive compulsive disorder, may help in arresting further aggravation of Acne Excoriée

What is the Prognosis of Acne Excoriée? (Outcomes/Resolutions)

• Adequate treatment of acne can help resolve the condition in many cases. However, in individuals with Acne Excoriée, the underlying cause of skin picking or scratching must be addressed to ensure better outcomes
• Severely Excoriated Acne may lead to severe facial or skin disfigurement resulting in further emotional trauma, stress, and reduced self-esteem
• The prognosis also depends on the severity of the underlying psychological disorder; individuals with mild disorder may have a better prognosis than those with severe psychological conditions

Additional and Relevant Useful Information for Acne Excoriée:

Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition.