- Best ResultsDepends on insight
- Treatment RecoveryNA
- Procedure TimeNA
- Skin SpecialistDermatologist, Psychologist
- Duration of ResultsCan be permanent
- AnaestheticNA
- Back to WorkNA
- Cost$
Can't stop 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 can you 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-
- See a dermatologist to place acne in complete remission. This means zero pimples, cysts, blackheads, zits & whiteheads. Options below.
- 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 Dermatology 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
Picking acne is the subtype that has the highest rate of lifelong scars. Early & effective control can prevent scars.
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.
Can’t stop picking acne? Here are natural ways to stop-
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.
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How to naturally reduce OCD & picking itself?
Probably best take it up with your yoga instructor, acupuncturist, aroma therapist or your meditation coach. They can discuss natural ways to chill out legally without lighting up a blunt.
Failing natural treatments, a doctor can prescribe SSRIs such as Prozac. Don’t see a dermatologist if you want natural treatments as they will prescribe you drugs such as vitamin A-isotretinoin, birth control pills, anti-hormones, or antibiotics.
What are simple ways to stop picking and reduce scarring?
If you have good self-control, it will save you a whole lot of time, effort & money. Failing that you can try simple steps like acne patches or hydrocolloid dressings. They can be purchased at most pharmacies, and cost less than 10 cents per patch. Acne patches provide you with haptic feedback, making it easier for you to stop picking your zits.
Another DIY tip is to learn CBT or Cognitive Behavioral Therapy. Watch a few YouTube videos to understand how this can benefit your urge to pick & scratch.
What are simple DIY treatments for acne scars?
Read the section on DIY treatments, but before you start, make sure your acne is under absolute & total control. If you can count more than 2-3 zits, you are not yet ready for scar revision.
DIY procedures such as sensible micro needling with a stamper (0.1 to 0.2 mm long) can help. This can be combined with retinol, & collagen stimulators such as peptides.
What can a psychiatrist bring to the table?
Drugs. Yup, one of the most effective therapies are selective serotonin reuptake inhibitors such as fluoxetine & paroxetine. These drugs are highly effective in the management of obsessive-compulsive disorders.
Cut the fluff, what is the fastest way to cure acne excoriee?
If you are frustrated with this condition, & if you have some insight, the fastest way to cure picking acne (and prevent long term scarring) is as follows-
- Dermatologist: Prescribe isotretinoin orally, 10-40 mg. 4-8 months in the absence of contraindications. Other options include antihormonal tablets.
- Psychiatrist or GP, prescribe you Prozac over 2- 8 months.
- Psychologists will teach you CBT, over 4-10 visits.
The above is the fastest way without the bullsh*t of naturopathic herbs, yoga, acupuncture & aromatherapy. If you are inclined for natural treatment, give it a go for a defined period (say 2-4 months). Take pre & post photos to objectively decide if this route works for you. Most dermatologists encourage natural remedies as a first step for non-life treating conditions. Dermatologists prescribe drugs, as do psychiatrists
How do I approach scarring from picking acne / acne excoriee?
For patients in complete remission, I employ surgical & laser modalities to repair scars. See the section on scar revision to understand.
For those who still have active acne, I highly recommend seeing a medical dermatologist to have this treated. Scarring in the presence of active acne can be treated with pico lasers, fractional lasers, micro needling, LLEDs & vascular lasers. These treatments are performed by my clinical staff at Cutis Dermatology. I do not operate on patients with active acne.
How do you know if your acne is in remission?
Never make a judgement about how you feel about your acne, this is inaccurate as it is subjective. Remission is about quantifying acne objectively. This is best done with a lesion count (not by you, but someone else). Take a photo then use this as a comparison.
Active acne is characterized by blackheads, cysts, microcysts, pimples & zits, as well as open ‘sores’. If you don’t have any of the above, your disease is in remission. A remission period of 3 months or longer heralds a good prognosis.
Who to see for help?
If you have this condition, my colleagues can make a difference in your skin’s health. Medical dermatologists at Clinic will give you options to place acne in remission.
If you are inclined to natural ways to treat your condition, see my nurses & dermal therapists as they can treat your condition with chemical peels, low level light treatments, vascular laser & carbon laser peels. They can also start you on a basic scar prevention & revision program.
Disclaimer: My work is procedural, namely I treat severe recalcitrant scarring with laser, surgical & peel techniques. I do not treat medical conditions including acne. I do not operate on cases of picking acne until this condition is in complete remission.
How much are treatments?
Embarrassingly affordable, given the amount of absolute crap out there. Majority of medications are on PBS, so it will cost you about $1.80 a day.
CBT by a psychologist is also subsidized by Medicare for up to 10 sessions. Private health can top up, if you have cover. Partial Medicare rebates apply to see a dermatologist or a psychiatrist. SSRIs cost approximately 60-90 cents a day.
Simple scar revision by my clinical staff ranges from $390 to $990 per session.
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.
