Excoriated Acne — More Than Skin Deep

Acne may be a physical problem, but its origins sometimes lie in an emotional disorder. Excoriated acne is caused by an uncontrollable urge to pick at the skin, which can leave deep acne scars.

You may be tempted to squeeze or pick at a particularly large pimple that erupts on your nose or cheek or chin. But when the urge to pick and pop is overwhelming, and you spend hours scrutinizing and picking at your skin, excoriated acne can result.

Excoriated acne is a type of acne with a unique cause. The word excoriate means to tear or scratch off the skin. Excoriated acne is characterized by an intense, uncontrollable urge to squeeze and pick at every pimple on the skin — even a tiny, barely noticeable blemish. Squeezing the occasional pimple isn't considered excoriated acne — it occurs only when the habit becomes constant and uncontrollable.

People with excoriated acne may spend hours gazing into a mirror, inspecting and picking at their blemishes and skin. All that picking and squeezing only makes acne worse, causing red marks and scarring. If it’s constant, deep acne scars can result — and even be permanent.

Open wounds on the skin where a pimple or blemish has been squeezed or picked are typical symptoms of excoriated acne. Those with excoriated acne may use tools to help them pick at their skin, including:

Tweezers

Their teeth

Knives or pins

Nail files

Most often, the blemishes and picking occur on lesions found on the face, arms, and upper back area — places that are easy to reach. People with excoriated acne may pick because they feel like their skin is itching.

Why People Pick at Pimples

Excoriated acne usually starts as simple, minor acne — the occasional pimple or blemish that wouldn't bother most people. But some become obsessed with their acne and can't keep their hands from squeezing or scratching their skin. The minor acne becomes severe because of a behavioral disorder that fuels the impulse to constantly pick at the skin — then it becomes a physical and emotional issue that requires treatment.

This type of acne most often occurs in young women, particularly those who are very concerned about their appearance and easily become distraught about even the smallest pimple. Overall, it occurs in about 2 percent of those with acne.

Underlying emotional health issues that can contribute to excoriated acne include:

Depression

Obsessive-compulsive disorder

Anxiety

Excoriated Acne Treatment

You can treat the acne itself — but without behavioral therapy, the picking and squeezing will only continue, thus worsening acne and acne scars. A dermatologist may recommend counseling and psychotherapy to help people with excoriated acne understand why they feel the impulse to pick at their skin, and learn ways to redirect those feelings. An antidepressant or anti-anxiety medication may be prescribed as part of the acne treatment plan to help manage the underlying mental health issue and alleviate the impulse to pick at the skin.