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Acne Excoriee - Causes, Symptoms, and Treatment

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Acne excoriee is a medical term that defines scratched or picked pimples that often result in scars and scabs. The below article details this condition.

Medically reviewed by

Dr. Sandhya Narayanan Kutty

Published At November 9, 2023
Reviewed AtNovember 9, 2023

What Is Acne Excoriee?

Acne excoriee, often called picker's acne, occurs when acne lesions are compulsively scratched and squeezed, resulting in scabs and scars. This worsens the condition making acne look more unsightly. It is most common in adolescent girls and is believed to be linked to underlying depression, anxiety, or emotional problems. Acne vulgaris, or acne, is caused by numerous factors. Overproduction of sebum (an oily, waxy substance produced in the sebaceous or oil glands) increases due to hormonal imbalances. This, combined with less shedding of exfoliating dead skin cells, clogs hair follicles. The clogged follicle may become inflamed and increase the growth of normal skin bacteria, Propionibacterium acnes. In addition, certain medications like Isoniazid lithium, Cortisone, iodides, and anticonvulsants can also cause acne lesions. Acne can result in permanent scarring or may become secondarily infected so minimizing breakouts is necessary. Acne affects 85 % to 100 % of individuals at some point in their lives and usually starts at puberty.

What Causes Acne Excoriee?

Acne excoriee is caused by repeatedly picking or scratching on acne lesions, which results in oozing of pus and bleeding and can lead to deep scars on the skin. In addition, some individuals with emotional or psychological issues, such as obsessive-compulsive disorder (OCD), depression, anxiety, or emotional problems, are habituated to subjecting their acne to compulsively picking on their skin with tweezers, pins, or fingernails (even minor lesions). The picking aggravates the acne and causes scars. As a result, scarring leads to more acne and, eventually, more picking.

Who Gets Acne Excoriee?

Anyone who develops acne can suffer from acne excorieee. It is generally more common among teen girls and women than men. Spending hours in front of the mirror can also mean stress or depression. Psychiatrists classify acne excoriee with body dysmorphic disorder (bodily-focused anxiety).

What Are the Symptoms of Acne Excoriee?

Acne results in a wide variety of skin lesions. Acne most commonly involves the face, neck, chest, and back, where the sebaceous glands are the most. Acne signs vary based on the severity of the condition:

  • Blackheads (open plugged pores).

  • Whiteheads (closed plugged pores).

  • Small red, tender bumps (papules).

  • Painful, fluid-filled lumps under the skin (cystic lesions).

  • Large, solid, painful lumps beneath the skin (nodules).

  • Pimples (pustules), with pus at their tips.

Picking or scratching acne can lead to scabs, shallow sores, and permanent scars, which may occur as depressions in the skin or hyperpigmentation, which are dark red or brown flat marks where the acne lesions were located. In addition, picking at the skin may last long after the acne has improved. All of these forms of acne can influence self-esteem. Therefore, it is best to seek assistance from a healthcare provider early so they can help determine the most suitable treatment option.

How Is Acne Excoriee Treated?

Treatment of acne excoriee typically depends on whether or not the person has primary acne lesions. In addition, one may need stronger prescription medications depending on their condition's severity, age, type of active acne, and how effective the over-the-counter medications have been.

Topical Medications:

  • Retinoids and Retinoid-Like Drugs: Drugs containing retinoic acids or Tretinoin are often helpful for treating moderate acne. They are available as creams, gels, and lotions. Examples include Tretinoin, Adapalene, and Tazarotene. These medications prevent the clogging of hair follicles. However, topical retinoids increase the skin's sun sensitivity and cause dry skin, irritation, and redness, particularly in people with black skin. Also, these medications are not spotted treatments, so they must be used on the whole skin affected by acne to prevent new outbreaks.

  • Antibiotics: Topical antibiotics like Clindamycin and Erythromycin are effective in controlling surface bacteria that aggravate and often stimulate the swelling of acne. Antibiotics are more efficacious when used in combination with Benzoyl peroxide. Therefore, topical antibiotics are not recommended alone.

  • Azelaic Acid and Salicylic Acid: Salicylic acid is available over the counter for acne as a cleanser or lotion. It helps remove the upper layer of damaged skin. In addition, it dissolves dead skin cells to prevent the hair follicles from plugging. Azelaic acid is a natural dicarboxylic acid produced by yeast that kills microorganisms on the skin and reduces swelling. A 20 % Azelaic acid cream or gel is known to be effective as many traditional acne treatments when used twice a day. In addition, prescription Azelaic acid can be used during pregnancy and while breastfeeding. It can also help manage discoloration that happens with some forms of acne. Side effects of Azelaic and Salicylic acid include skin redness and minor skin irritation.

  • Dapsone: This 5 % topical gel also has antibacterial properties, often recommended for inflamed acne, particularly in women with acne. It is typically applied to the skin twice a day. Side effects include redness and dryness.

Oral Medications:

  • Oral Antibiotics: One may need oral antibiotics to reduce bacteria for moderate to severe acne. Usually, tetracycline (Minocycline, Doxycycline) or a macrolide (Erythromycin, Azithromycin) is the preferred acne treatment. In addition, a macrolide can be advised for people who can not take tetracyclines, like pregnant women and children under eight years old. However, oral antibiotics should not be used for long to prevent antibiotic resistance. Also, they should be combined with other drugs, such as Benzoyl peroxide, to decrease the likelihood of developing antibiotic resistance. However, these drugs can increase the skin's sun sensitivity.

  • Combined Oral Contraceptives: The Food and Drug Administration (FDA) has approved three kinds of oral contraceptives for treating acne in women who want to use them for contraception. These contain a combination of two hormones-estrogen and progesterone. One may overlook the benefit of oral contraceptives for a few months, so using other acne medications for the first few weeks can help. However, combined oral contraceptives carry side effects such as weight gain, breast tenderness, nausea, and increased risk of cardiovascular problems, cervical cancer, and breast cancer.

  • Anti-Androgen Agents: Spironolactone may be suggested for women and adolescent girls if oral antibiotics are not working. It stops the effect of androgen hormones on the oil (sebaceous) glands. Potential side effects are breast tenderness and painful periods.

  • Isotretinoin: It is a derivative of vitamin A, which may be prescribed for people whose moderate or severe acne does not respond to other treatments. Oral Isotretinoin can cause depression, inflammatory bowel disease, and severe birth defects.

Other Therapies:

Depending on the condition, the healthcare professional may suggest one of the following therapies, either alone or combined with medication:

  • Lasers: Currently, laser therapy is mainly used to treat acne scars. A laser projects heat to the scarred collagen under the skin, which depends on the body's wound-healing response to make new, healthy collagen. This promotes the growth of new skin to replace it. There are different types of laser resurfacing, including ablative and non-ablative. The health care professional determines the best treatment according to the skin type and nature of acne scars.

  • Chemical Peels: This procedure uses special chemical solutions like Salicylic acid, retinoic acid, or glycolic acid to remove the upper layer of old skin. This treatment can help treat mild acne. In addition, it may enhance the appearance of the skin, though the change is not long-lasting, and repeat treatments are often needed.

  • Steroid Injections: Rarely can steroids be injected to treat nodular and cystic lesions to reduce inflammation. However, this can cause skin thinning and discoloration in the treated area.

  • Drainage and Extraction: The health care professional may use special tools to gently remove blackheads and whiteheads or cysts that have not healed with topical medications. This procedure temporarily enhances the appearance of the skin, but it can also cause scarring.

Self-Care Guidelines:

Conventional acne treatments usually do not control the habit of picking at the skin. One can try to avoid mild or moderate acne with nonprescription products, a good basic skincare regime, and other self-care techniques:

  • Wash the face daily with a gentle facial cleanser and water.

  • Use a moisturizer daily.

  • Switch to non-comedogenic or water-based makeup products and remove makeup before bed.

  • Use over-the-counter acne products to dry excess oil and encourage peeling.

  • Avoid irritants like sunscreens, oily or greasy cosmetics, and hairstyling products that can worsen acne. If possible, try to stay out of the sun and regularly use a non-comedogenic moisturizer that includes sunscreen.

  • Protect the skin from the sun.

  • Avoid pressure or friction on the skin. Protect acne-prone skin from contact with phones, tight collars, helmets, straps, and backpacks.

  • Avoid picking or touching acne-prone areas. This can trigger more acne to form or lead to infection or scarring.

  • Shower or take a bath after strenuous activities. Oil and sweat on the skin can lead to breakouts.

  • Acne can have substantial psychological effects. Talk to a healthcare provider about any feelings of depression. Counseling can be a pivotal factor in the improvement of acne excoriee.

Conclusion:

Acne excoriee is a skin condition when the affected person picks or scratches the acne lesions. It can be extremely upsetting and embarrassing. Most people pick or squeeze some of their spots to be rid of them. However, the acne may become secondarily infected, and picking it may cause scarring. In addition, depression, anxiety, and other emotional problems may accompany acne excoriee. Counseling may be recommended if there is excessive anxiety or depression. Seek medical care for moderate or severe acne that has not improved enough with self-care techniques.

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Dr. Sandhya Narayanan Kutty
Dr. Sandhya Narayanan Kutty

Venereology

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