Also known as picker's acne, acne excoriée is a disease seen most commonly in adolescent girls and young women.

It is a subtype of skin-picking disorder (SPD) that is directed at acne lesions and is typically limited to the face. SPD, also known as excoriation disorder, was introduced in the most recent (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5. SPD encompasses several different diagnoses that involve repetitive manipulations of the skin, including acne excoriée. SPD is a distinct entity in the group of the obsessive-compulsive and related disorders, along with trichotillomania and body dysmorphic disorder.

The DSM-5 diagnostic criteria for skin-picking disorder are as follows:

• Recurrent skin picking resulting in skin lesions.
• Repeated attempts to decrease or stop skin picking.
• The skin picking causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The skin picking is not attributable to the physiologic effect of a substance or another medical condition.
• The skin picking is not better explained by symptoms of another mental disorder.

The underlying acne vulgaris is usually mild. Affected individuals compulsively pick at and squeeze minor superficial lesions. As a result of this irritation, secondary lesions develop that scar and cause atrophy. In a small number of cases, acne lesions may itch, or the patient may have dermatographic itch localized to the face and lesions of acne. Healing ulcerations may itch as well. Acne excoriée differs from most artifactual dermatoses in that the patient will often admit to creating the lesions.

Related topic: Neurotic excoriations