Section : Conference Notes

Acne Excoriee: Treatment of a psychological disease

  • Acne excoriee (AE) is a psychodermatosis which typically affects young women.
  • It is a self-inflicted dermatosis which is  admitted by the patients
  • The patients pick on imagined papules and on physical examination, none of the elementary lesions of acne (comedones) are present.
  • 2 types of psychological mechanisms explain the picking:
    • habitual picking
    • emotional picking
  • Treatment is mainly behavioural as medication (for acne or for the psychololgical distress) are notoriously ineffective.
  • A more effective treatment is through a psychological/ therapy: Habit Reversal therapy and/or Relaxation. Habit reversal therapy (HrT) reduces scratching in eczema patients and can be helpful in patients with AE with habitual picking


  • 1. psychorelaxation of mind and education of unconscious habits
  • 2. building awareness by counting number of picks per day
  • 3. educating new strategies
    • clenching fists
    • distraction techniques (keeping hands busy, stress ball). Designing strategies to cope with acute stress situations
    • motivational


  • psychoeducation: emotional picking, triggers and reaction to stress
  • learning relaxation techniques: controlling heart rates by breathing techniques
  • doingit initially 2-5 minutes a day then usind 30 minutes when stressed
  • learning to accept stressful thoughts (not suppressing them), but simply learning the body to live with it stress-free
  • build self-confidence.
  • Stress is a cause of emotional picking
  • In this retrospetive study from the UK:
    • done on 3 patients presenting to a clinical psychology section of a psychodermatology service were enrolled
    • the mean age was 30 years
    • 8 sessions of HrT
  • Results
    • medical treatment was unsuccessful
    • but learning to focus on the advantages of enhancing appearance was (positive-attitude)
    • HrT:
      • Enabled reduction in picking and hence increased appearance resulted in reduction of:
        • anxiety scores
        • depression scores
        • …and increased quality of life.


  • Acne excoriee is challenging to treat
  • Work with a psychologist to assess and treat habitual and emotional picking.


Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Source of information: 2014 (03) – Di Nardo A., A psychological intervention with people with acne excoriee: a case series. 72nd AAD (American Academy of Dermatology) Annual Meeting (Denver, CO, United States of America)