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

HrT

• 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

Relaxation

• 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.

Conclusion:

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

Contributors

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)