SKINIPEDIA - Skin Encyclopedia: Acne Excoriee (Face Picking)

Face Picking - Acne Excoriee

The medical term for picking at one’s face is "Acne Excoriee" literally meaning picked pimples which comes from "Acne Excoriee des Jeunes Filles" literally translating from the French to mean “acne created by young girls.” It was titled so because of the abundance of young girls who ‘fiddle’ with or aggravate their skin to the point where they cause major problems where there were only minor problems or even no problems at all. The result is scabs and various ulcerations usually on the front of the face. And interestingly enough, the habit of skin picking is far more prevalent among women then men.

When this habit of picking is taken to the extreme on other parts of the body it is termed Neurotic Excoriations or “Picker's Nodules”. The name explains it what it is, but fails to express how painful and debilitating this disease can be. Self inflicted or self aggravated open sores and scabs appearing all over the body are not uncommon. Neurotic Excoriations usually begin with a chronic fungal skin infection or Lichen Simplex Cronicus. When the scabs fail to heal in a timely manner , the patient feels a irrepresible need to pick off the scabs feeling it is better to live with the open sores than the scabs. Sometimes it is felt that the wounds will heal better if the scabs are picked off. This is not an uncommon feeling in the case of Acne Excoriee des Jeunes Filles as well.

Acne Excoriee is recognizable because the lesions left behind from picking have a pronounced look to them. The upper and lower epidermis are usually scraped off leaving raw looking scrapes and flat lesions of hyperpigmentation.

Acne excoriée, also known as "picker's acne," results when acne lesions are compulsively squeezed and scratched, resulting in scabs and scars. It is seen most commonly in adolescent girls and has been thought to be associated with underlying depression, anxiety, or emotional problems.

Acne, also known as acne vulgaris, is thought to be caused by multiple factors. Overproduction of a normal oil on the skin, called sebum, increases under the influence of hormones. This, coupled with insufficient shedding of exfoliating dead skin cells, plugs hair follicles. The plugged follicle can become inflamed and have increased growth of normal skin bacteria, Propionibacterium acnes. Medications such as lithium, cortisone, hormones, iodides, some seizure medications, or isoniazid can also cause acne lesions.

Acne can result in permanent scarring, so minimizing breakouts is important.

Acne results in a variety of lesions. The most common acne locations include the face, neck, chest, and back, where the most sebaceous glands are located. "Blackheads" (open comedones) and "whiteheads" (closed comedones) are follicular plugs that are either oxidized from being exposed to the air (blackhead) or sitting below the skin surface (whitehead). Papules are small pink to reddish-brown bumps; pustules are superficial pus-filled lesions, and nodules or cysts are deeper pus-filled lesions.

Mild acne consists of a few papules/pustules and/or comedones. Moderate acne has an increased number of lesions. Severe acne has numerous comedones, papules, and pustules and may have painful nodules.

Picking can result in scabs, shallow sores, and permanent scars, which can either appear as depressions in the skin or hyperpigmentation, which is dark red or brown flat marks where the acne lesions were. The habit of picking at the skin may persist long after the acne has improved.

There is no cure for acne. Acne can result in scarring, so minimizing breakouts is important.

Traditional treatments can help. Cleanse the acne-prone areas with gentle soaps or cleansers, and avoid irritants, such as rubbing and other alcohols, and abrasive scrubs and greasy products on the skin and in the scalp. Products labeled "water-based" or "noncomedogenic" will help reduce clogged pores.

There are also a variety of over-the-counter medications that may help. These are meant to be preventative therapies and should be applied in a thin layer to the entire area on a regular basis. If applied consistently you may see small improvements quickly, but results are generally seen after a few months. Benzoyl peroxide (most effective), is available in a variety of forms and strengths. Benzoyl peroxides tend to dry the skin, though, so if you have dry skin, use a weaker-concentration product; for oily skin, consider higher strengths. It can also bleach your clothing and towels. Peeling agents (exfoliants) such as salicylic acid, sulfur, resorcinol, and alpha-hydroxy acids (glycolic, lactic, pyruvic, and citric acid) can also help but will cause some dryness of the skin as well.

In acne excoriée, the habit of picking at the skin must be stopped. This habit may still persist after the acne has improved and may require behavioral therapy or counseling.

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