Acne excoriée is an excoriation disorder defined by the uncontrollable desire to pick, scratch, or rub acne lesions. It’s a mental health condition that falls into the group of obsessive-compulsive disorders. Learn about the symptoms of acne excoriée and how to treat it.
Having acne is no walk in the park, but it’s also nothing to be ashamed of or embarrassed about. According to the American Academy of Dermatology Association, approximately “85 percent of people between the ages of 12 and 24 experience at least minor acne” and “up to 15 percent of women” in adulthood also experience it. Everyone’s journey with acne is different, but Face Reality Skincare conducted a national acne survey of 1,000 people in the US for Acne Awareness Month in June and found that there are many shared experiences. For example, 95 percent of people report they pick their acne, which can be known as “acne excoriée.”
Acne excoriée is a condition that falls into the group of obsessive-compulsive disorders (OCD). “Acne excoriée is an excoriation disorder in which patients have a conscious, repetitive, and uncontrollable desire to pick, scratch, or rub acne lesions,” according to the American Osteopathic College of Dermatology.
“It’s related to compulsive skin picking,” clinical psychologist Jenny Yip, ABPP, tells POPSUGAR. “It occurs when you have the urge to perfect your skin, therefore, you’re going to pick at any tactile or visual blemishes on your skin. The problem is that the more you pick, the more scabs you’re creating on your skin, which triggers further tactile urges to pick at the imperfection.”
However, just because you pick at your pimples doesn’t mean you have acne excoriée. “Picking an occasional pimple, while not recommended, is considered completely normal,” says Alex Hernandez, licensed aesthetician and lead educator for Face Reality.
To get diagnosed, it’s best to seek consult from a mental health professional and/or a dermatologist. Acne excoriée can be present with all forms of acne: inflamed acne, non-inflamed acne, or a combination of them. “When picking at non-inflamed lesions such as whiteheads and blackheads, bacteria from hands can cause inflammation, leading to new lesions forming and the worsening of existing lesions,” Hernandez says.
Triggers for the condition can be acne, but also ingrown hairs, scabs, and any marking that looks or feels “imperfect” to the touch. “The compulsive skin picking happens when you’re picking at your skin in order to perfect it because it either doesn’t feel perfect to your fingertips or it doesn’t look perfect,” Dr. Yip says. But picking only exasperates the issue.
The cycle goes something like this: “When you have the urge to make something perfect, it builds a lot of anxiety and discomfort,” Dr. Yip says. “The resulting urge drives you to pick at your skin. But then, your skin is even more imperfect, which triggers even more discomfort. It becomes a vicious cycle.”
Picking, scratching, or popping lesions or pimples can lead to a variety of skin complications. “This disorder can lead to open sores, wounds, scabs, and moderate to severe scarring,” Hernandez says.
First and foremost, if you have acne excoriée, you should seek help from a mental health professional who specializes in OCD and picking disorders, as well as a dermatologist.
“The evidence-based treatment for skin picking involves a combination of exposure and response prevention therapy (ERP) and habit reversal training (HRT),” Dr. Yip says. “ERP would involve exposing you to your own imperfect skin, as it is. It’s about understanding that all of our skin is flawed — no one has perfect skin. It’s also building tolerance to your own skin and accepting your skin’s flaws, as they are.”
HRT, on the other hand, teaches you to have a new response to acne excoriée. “Instead of picking at your skin, you might be fidgeting with a squeegee ball or a brush,” Dr. Yip says. “Part of HRT is to teach you to identify the specific where, when, and how you pick, to increase your mindfulness of the situations.”
To treat present acne, dermatologists can prescribe medication or topicals. Regular visits to an aesthetician can also help. “Corrective treatments, such as a chemical peel or microneedling, will be needed to improve hyperpigmentation and texture left behind from picking,” Hernandez says.
Remember: the occasional pick at a pimple or scab is OK, but if you experience an uncontrollable desire to pick at your skin that results in injury, it may be time to seek help from a professional.