Excoriated Acne: What It Is and How to Treat It

Complications of Compulsive Picking at Blemishes

Acne during the preteen years is very common.
Acne during the preteen years is very common. Photo: Image Source / Getty Images

Most people have, at some point or another, given in to the temptation to pick at a blemish. But for some, the picking goes on to the point where skin tissue is damaged, sometimes severely. This is known as excoriated acne.

Causes of Excoriated Acne

Excoriated acne occurs when pimples have been scratched or picked to the point of wounding the skin. Although anyone can develop excoriated acne, it tends to occur more frequently in women.

For many, excoriated acne can begin as a common case of acne vulgaris. Other times, it can be the result of picking at imagined blemishes or minuscule comedones that are barely visible.

Those with chronic excoriated acne tend to be people who cannot control their compulsive urge to scratch or pick at their skin. The constant squeezing and picking can cause open sores. When these sores scab up, they lend themselves to more picking. It becomes a vicious cycle that is hard to break.

The habit may reach the level of being diagnosable as excoriation disorder. This is now listed as a distinct obsessive-compulsive disorder in the "Diagnostic and Statistical Manual of Mental Disorders, 5th Edition."

Symptoms and Complications

Depending on how much the person has picked at the skin, excoriated acne may range in appearance from angry red bumps or scratches, to open red sores, crusting, and scabs. At the very least, the constant squeezing makes blemishes more inflamed.

At worst, picking at the skin can cause open wounds. These wounds can become quite large and deep as the person continues to pick at the sore.

Squeezing a pimple can lead to a nodule (hard, red, painful blemish deep within the skin) or a cyst. A cyst develops when a membrane forms around the infection in the dermis, creating a soft, fluid-filled lump that can become large and painfully inflamed.

Excoriated acne is often accompanied by post-inflammatory hyperpigmentation. Where the skin has been picked to the point of permanently damaging the tissue, scarring can occur.

Treatment

Acne breakouts can be treated with an over-the-counter product or prescription medication. Antibiotics may be needed if the lesions are infected. But these treatments won't combat the most significant source of concern—the constant picking at the skin.

People with excoriated acne usually wish they could stop picking at their skin. Sometimes, a dermatologist may be able to help by explaining the importance of a "hands-off" policy. But often it isn't a matter of willpower. This form of acne may also be accompanied by anxiety disorders, ADHD, depression, or other mood disorders.

Treatment for excoriated acne is tailored to the individual. In addition to acne medications, those with excoriated acne may benefit from psychological counseling, drug therapies for those with underlying mood disorders, or substitution therapies.

A Word From Verywell

If you have the compulsive desire to pick at your skin, you need to talk with your dermatologist or family practitioner. Don't be embarrassed. This is a recognized medical condition and help is available.

Source:

Lochner C, Roos A, Stein D. Excoriation (skin-picking) disorder: a systematic review of treatment options. Neuropsychiatric Disease and Treatment. 2017;Volume 13:1867-1872. doi:10.2147/ndt.s121138.

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