Acne: acne excoriee

Acne excoriée results when acne lesions are compulsively squeezed and scratched, resulting in scabs and scars.

This chapter is set out as follows: 

Acne excoriée is uncommon and occurs particularly in young females. There are two reasons for acne excoriée presenting:

• 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 the body dysmorphic disorder 

• Management requires a multidisciplinary approach

• 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. Such patients should be referred for psychological assessment and management 

• 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 dermatology for consideration of oral retinoids. For management advice refer to the acne section in the concise guidelines