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Dr. Alpana Mohta Ranka, MD, DNB, IFAAD, is a dual-board-certified dermatologist with over 90 research publications in peer-reviewed scientific journals.


Acne Excoriee: Treatment and Causes

Updated: Nov 24, 2023

Acne is a common skin concern that can significantly impact not just our skin but also our self-esteem and well-being. Among the various forms of acne, one that requires special attention and understanding is "Acne Excoriée."

As a seasoned dermatologist, I am here to shed light on this condition, explaining its causes, treatment modalities, and preventive strategies to help you achieve clearer and healthier skin.


Table of Contents


What is Acne Excoriée or Picker's Acne?

Acne excoriée, also known as "picker's acne" or "psychogenic excoriation," is a common manifestation of acne. It is a form of "pathologic grooming" that results from compulsive picking, scratching, or squeezing of blemishes.

Acne induced dark spots on a woman's face with her picking at them

This impulsive behavior often stems from psychological factors like anxiety, stress, or obsessive-compulsive tendencies. The repeated manipulation of acne lesions can exacerbate inflammation, delay healing, and cause secondary infections, leading to a vicious cycle of worsening skin conditions.

Causes of Acne Excoriée: The Psychological Connection

Acne excoriée has a strong psychological underpinning. Individuals who engage in this behavior often do so as a coping mechanism to relieve stress, anxiety, or negative emotions.

The physical act of picking at blemishes may provide momentary relief, but it ultimately perpetuates the cycle of acne and worsens the skin's appearance.

The vicious cycle of acne excoriee consists of the following steps. Appearance  of acne, skin picking, scars, mental stress in a repetitive vicious cycle.

How to Know if You Have Acne Excoriée?

According to the Journal of American Academy of Dermatology Case Reports, one main sign of acne excoriée is an overwhelming desire to scratch or pick at the skin, which usually happens when you're not very busy. This feeling comes with the thought that picking will make the skin smoother, and there's a sense of comfort while doing it. But afterward, there's a strong feeling of wishing you hadn't done it, especially if it causes the skin to become sore or bleed. The picking is noticeable enough that family members notice and try to stop it.

Following are some behaviors you might exhibit:

  • Spending hours in front of a mirror squeezing out all the acne.

  • Plenty of scars & pigmented spots on the face with no active acne.

  • A feeling of undue stress about your appearance.

How to Treat Acne Excoriée: Healing the Skin and Mind

Addressing acne excoriée requires a holistic approach combining dermatological interventions and psychological support. Here's how:

  1. Dermatological Treatment:

    1. Topical Treatments: Dermatologists may prescribe topical treatments containing ingredients like benzoyl peroxide, salicylic acid, retinoids, azelaic acid, or antibiotics (clindamycin, erythromycin, dapsone, nadifloxacin, etc) to manage acne and reduce inflammation.

    2. Oral Medications: In some cases, oral antibiotics, oral retinoids, or oral contraceptives (for hormonal acne) may be recommended to control acne and prevent further worsening.

    3. Wound Healing: Specialized wound care products like silicone gel or hydrocolloids like acne patches can help accelerate the healing of picked lesions and prevent infection.

Please note that the medications should always come from your treating physicians or dermatologists.

  1. Psychological Support:

    1. Counseling and Therapy: Cognitive-behavioral therapy (CBT) or psychotherapy can help individuals address the underlying psychological triggers of compulsive picking.

    2. Stress Management: Learning stress-reduction techniques such as mindfulness, meditation, and deep breathing can aid in managing the urge to pick.

    3. Support Groups: Connecting with others who share similar struggles can provide a sense of community and encouragement to overcome the behavior.

Acne Excoriee Prevention Strategies: Nurturing Healthy Skin Habits

Preventing acne excoriée involves adopting healthy skincare habits and promoting emotional well-being:

  1. Physical methods: The top tip I have for those dealing with acne excoriée is to get rid of things that might set it off, like a magnifying mirror or comedone extractors. Wear gloves, keep your nails short, and cover your acne with acne patches to lower skin picking and self-harm. An acne patch product that has great reviews and you could use is the Mighty Patch Original from Hero Cosmetics Call me crazy, but you can also use these finger gloves to prevent picking at your pimples. What? They work! Silicone Finger Sleeves Cover Protection for Finger Tips

  2. Hands-Off Approach: Avoid touching, picking, or squeezing acne lesions to prevent further irritation and inflammation. Support groups on the internet, like, provide easily accessible help through info, exercises, and chat sessions to help you with breaking the vicious cycle of picking your skin.

  3. Wearables: Other tech solutions like the Keen bracelet and Tingle wearable can also help in regulating your behavior. They work by monitoring any repetitive skin-picking gestures of your hands. Although these devices offer a promising solution, there is limited proof of their effectiveness.

  4. Skincare Routine: Establish a gentle skincare routine using non-comedogenic products to maintain skin health.

  5. Stress Reduction: Engage in activities that promote relaxation and reduce stress, such as exercise, hobbies, and spending time with loved ones. As part of your coping techniques, you can also do journaling or use a fidget toy to prevent the urge to pick on your skin. This fidget toy for reducing stress and preventing skin picking is supposed to have really great reviews: ONO Roller Jr Purple - Silent Fidget Toys for Promoting Focus & Stress Relief

  6. Professional Help: Seek assistance from a dermatologist and mental health professional to create a personalized treatment plan.


Check out some of our other related articles:


To Wrap it Up

Acne excoriée is a complex skin condition requiring a comprehensive approach encompassing dermatological care and psychological support.

Acne is a normal part of life, and so are the dark spots that appear after these pesky little mountains decide to squat on your skin. What's important is that you don't mess around with picking them, as it can cause scars that may be semi-permanent.

As for the dark spots that appear even after you haven't messed with the pimples, you don't need to worry too much about them. You can get rid of them fairly easily. You ask how? Here's how:

These are various OTC products and treatment modalities that can help you get rid of them in an effective way. You can use AHA-based serums, azelaic acid, etc., to get rid of them.


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