Picking Acne – Acne excoriee

  • Best ResultsDepends on insight
  • Treatment RecoveryNA
  • Procedure TimeNA
  • Skin SpecialistDermatologist, Psychologist
  • Duration of ResultsCan be permanent
  • AnaestheticNA
  • Back to WorkNA
  • Cost$

Picking Acne - Acne excoriee

Acne excoriee is a common form of acne. In short it presents as erosions, scabs & scars due to conscious & subconscious habitual picking. Stress, anxiety & skin irritation are frequent comorbidities associated with picking acne. Scarring is universal, hence early & effective management will mitigate permanent scarring. 

FactsFacts on Acne Excoriee

  • This common subtype of acne can be easily treated if one has insight
  • You must effectively treat acne- every single zit, cyst, whitehead & pimple
  • Exercises such as cognitive behaviour therapy can help
  • For severe cases, medications to reduce anxiety & compulsion are highly effective
  • Alternative to drugs include meditation & yoga
  • Scar prevention is most important, followed by scar revision
  • The best investment you can make is to get some hydrocolloid acne patches
  • Acne picking should be in remission prior to scar revision

How to treat acne excoriee & picking?

Stop picking. Easier said than done. Let’s logically break it down. If the substrate for picking is gone (acne), picking will resolve & scars will be prevented. The remaining scars can be revised (see below). The two ways to cure picking acne are-

  1. See a dermatologist to place acne in complete remission. This means zero pimples, cysts, blackheads, zits & whiteheads. Options below.
  2. Stop the habitual manipulation of spots. Techniques such as Cognitive Behaviour Therapy (CBT) & Habit Reversal Training (HRT).  More below.

Disclaimer: I am a procedural dermatologist, I do not treat acne, only acne scars. If you have active acne, please seek professional help. My colleagues at Cutis Clinic can assist.

What is picking acne or acne excoriee?

This is a form of obsessive-compulsive disorder. Acne excoriee is a true medical condition. It has two components. Firstly, organic acne lesions, secondly the obsessive compulsive or the mental component. 

I firmly believe that acne excoriee is very different from skin picking or dermatillomania, the latter has no organic substrate. Both are treated along the same lines in the context of psychological behaviour modification.

The outlook for acne excoriee is excellent if patients have insight. The course is chronic & frustrating for patients who lack insight.

Can hormonal acne give rise to skin picking?

Hormonal acne is the most common type of acne associated with skin picking. Stress, anxiety & hormonal fluctuations give rise to adult female jawline hormonal acne.

Unlike normal acne, hormonal acne is deep. The location favours the lower face including the jawline, chin, & mandible. Deep cysts can be painful. Unlike surface lesions, squeezing is futile. 

Acne excoriee starts off by squeezing a few zits. This leads to frustration, then anxiety, & the cycle continues. Picking is essentially an ongoing habit. 

Why see a medical dermatologist?

A dermatologist can prescribe effective medications to reduce acne, and hence the substrate to pick. Remember the biggest predictive factor of long-term scarring is the time taken to effectively control all acne breakouts (it is not the time taken to try or ‘have a go’ at treatments). My colleagues will employ a combination of –

  • Topicals: including retinoids, anti-bacterial gels & lotions
  • Oral antibiotics: such as Tetracyclines, Bactrim & Erythromycin
  • Oral antihormones: including spironolactone & cyproterone acetate
  • Oral isotretinoin: or Accutane /Oratane/ Roaccutane

What can a psychologist do?

Psychologists can give you a whole lot of insight -if you are open to it. Psychologists prescribe therapy without drugs. They can accurately assess your habits & provide cognitive behaviour therapy as well as habit reversal training. I highly recommend seeing one, especially if you lack insight. Non-pharmacological therapy is important. You will not get that from a dermatologist or a psychiatrist.

What are natural ways to treat picking acne?

Bearing in mind that the most important factor in predicting the severity of acne scarring is the time taken to effectively & in most cases absolute control, you do have a whole smorgasbord of naturopathic methods to treat both your acne, anxiety & obsessive compulsion. Natural ways to treat acne include-

Acne diet. Essentially low sugar, no processed foods, no dairy. Supplement with zinc. More information in the section on acne.

Topicals include niacinamide, retinol as well as fruit acids & willow bark salicylic acid. Tea tree oil & vitamin C is probably not a good idea as these can cause skin irritation, especially on open picking lesions.

Light phototherapy is a good option, especially a mix of red & yellow light. Lasers are actually monochromatic light sources, vascular lasers can kill c.acne bugs, & provide faster healing, especially if you have red scars.

Davin’s Viewpoint on picking acne / acne excoriee

This is one of the most common causes of acne scarring. Picking acne can be effectively managed within a relatively short time, if patients have insight. If they lack insight or are in denial, it is chronic, & can span decades. It is a form of OCD or obsessive-compulsive disorder. The fastest way to remission is to have acne treated effectively, as this also reduces acne scarring. Scarring is universally seen with picking acne, as physical manipulation (picking, gouging, squeezing) is deep.

Remember, the biggest prognostic factor for scarring is the time taken to effective & absolute control of acne. It is not the time taken to start a new treatment or to try out creams, skin care, diets, naturopathic or even medical treatments.

In summary, the most efficient way to treat acne excoriee is to see a medical dermatologist for control. Apply hydrocolloid patches to new lesions as this can reduce scarring & picking. CBT by a psychologist should be started early, give it four sessions. If the habit cannot be broken see a psychiatrist for prescription options. Remember scarring is directly related to the time taken for absolute control.

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