December 19, 2011 Most people have, at some point or another, given in to the temptation to pick at a blemish. But for some, the picking goes on to the point where skin tissue is damaged, sometimes severely. How You Can Cause Excoriated Acne Excoriated acne occurs when pimples have been scratched or picked, to the point of wounding the skin. Although anyone can develop excoriated acne, it tends to occur more frequently in women. For many, excoriated acne can begin as a common case of acne vulgaris. Other times, it can be the result of picking at imagined blemishes or minuscule comedones that are barely visible. While most people have, at some point, picked at an acne blemish, chronic sufferers of excoriated acne tend to be people who cannot control their urge to scratch or pick at their skin. They may feel a compulsion to pick at the skin. They may spend hours in front of a mirror, picking at their blemishes. The constant squeezing and picking can cause open sores. When these sores scab up, they lend themselves to more picking. It becomes a vicious cycle that is hard to break. What Excoriated Acne Looks Like Depending on how much the sufferer has picked at the skin, excoriated acne may range in appearance from angry red bumps or scratches, to open red sores, crusting, and scabs. At the very least, the constant squeezing makes blemishes more inflamed. At worst, picking at the skin can cause open wounds. These wounds can become quite large and deep as the sufferer continues to pick at the sore. Squeezing a pimple can lead to a nodule (hard, red, painful blemish deep within the skin) or a cyst. The most serious form of a blemish, cysts are large and painfully inflamed lesions. They develop when a membrane forms around the infection in the dermis, creating a soft, fluid-filled lump. Excoriated acne is often accompanied by post-inflammatory hyperpigmentation. Where the skin has been picked to the point of permanently damaging the tissue, scarring can occur. How Excoriated Acne Is Treated Acne breakouts that do occur can be treated with an over-the-counter product or prescription medication. Antibiotics may be needed if the lesions are infected. But these treatments won’t combat the most significant source of concern: the constant picking at the skin. People with excoriated acne usually wish they could stop picking at their skin. Sometimes, a dermatologist may be able to help by explaining the importance of a “hands-off” policy. But often it isn’t a matter of willpower. This form of acne may also be accompanied by anxiety disorders, ADHD, depression, or other mood disorders. Treatment for excoriated acne is tailored to the individual. In addition to acne medications, those with excoriated acne may benefit from psychological counseling, drug therapies for those with underlying mood disorders, or substitution therapies. If you have the compulsive desire to pick at your skin, you need to talk with your dermatologist or family practitioner. Don’t be embarrassed. This is a recognized medical condition. Doctor Lawrence Jaeger is a well known and respected board certified dermatologist and dermatologic surgeon who is the medical director of Advanced Dermatology Associates of New York, PC. Dr Larry Jaeger specializes in all aspect of medical, cosmetic and surgical dermatology.