follow @PCDSUKCreated: 10th November 2011 | Last Updated: 24th April 2017
Introduction
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Acne excoriée, results when acne lesions are compulsively squeezed and scratched, resulting in scabs and scars. This chapter is set out as follows: |
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Aetiology
- Acne excoriée is uncommon and occurs particularly in young females
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There are two reasons for this presentation:
- Very occasionally patients with very mild acne just pick acne spots in the belief that simply by so doing that will help the acne. A simple explanation from the doctor of the harm that they are doing can help considerably
- In the other subgroup, the majority, there may be underlying psychological problems, which are often difficult to unravel. There may even be no pathological acne lesions, the patient just scratches the skin - such patients may be considered to have dermatitis artifacta and / or dysmorphophobia
Images
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Figure: 1 Acne excoriée This patient had small amounts of acne, but her picking resulted in scars
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Figure: 2 Dermatitis artefacta No evidence of acne but the patient had been picking at her skin, which resulted in many scars
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Management
- Management requires a multidisciplinary approach
- The general practitioner may be in the best place to offer relevant management as they would know the patient and their family better than a consultant dermatologist
- Is the patient getting any acne? One way this can be determined is to ask the patient to come to see you as soon as a spot appears - if you never see a spot the patient may not have any acne, and so is suffering from dermatitis artefacta. The most severely affected patients may need to be referred to a psychiatrist
- If acne is present it needs to be managed effectively with the least irritant topical treatment, and also systemic antibiotics, where appropriate. If patients are not responding well, are scarring or have very marked psychological upset they should be referred promptly to see a dermatologist for consideration of isotretinoin