Acne excoriee des jeunes filles

Skin picking disease.

Disease in which the tiniest or non-existent impurities of the skin are consciously acted upon by scratching, pinching, pressing or similar manipulations.

According to the diagnostic and statistical manual of mental disorders (DSM-5), acne excoriée belongs to obsessive-compulsive disorders and not, as before, to impulse disorders. Clinically, however, this does not play a major role for the dermatologist. It is much more important to inform the patients about the psychological component and to work together with a psychiatrist or psychologist. Behavioural therapy is a good strategy. Unfortunately, anti-acne topicals (80%) or even largely pointless systemic therapeutics (40%) are still mainly prescribed, and psychiatric care is only organised for 5%.

Almost only women affected. A very high number of women have a mild clinical picture.

It is a special type of neurotic excoriations.

• Scratch excoriated papules and only in the minority acne-typical comedones or papulopustules.
• Blackheads on the nose have no disease value and need not be expressed.

• Medical history.
• Clinical features.

Face.

Ask for the insatiable impulse of expression. Patients are aware of this and do not hide it, unlike trichotillomania, for example.

Cut fingernails so that the white edge is no longer visible distally. This can attenuate the first seconds of push-pull behaviour. In addition, it is recommended to keep a diary of the manipulations, which makes the patients aware of the problem.

Usually, improvement occurs only after psychotherapy.

1. Arnold LM, Auchenbach MB, McElroy SL: Psychogenic excoriation. Clinical features, proposed diagnostic criteria, epidemiology and approaches to treatment. CNS Drugs 2001;15:351-359.
2. Niemeier V, Peters E, Gieler U: [Skin-picking disorder]. Hautarzt 2015;66:781-790; quiz 791-782.
3. George NM, Whitaker J, Vieira G, Geronimo JT, Bellinger DA, Fletcher CA, Garner JP: Antioxidant Therapies for Ulcerative Dermatitis: A Potential Model for Skin Picking Disorder. PLoS One 2015;10:e0132092.
4. Keuthen NJ, Koran LM, Aboujaoude E, Large MD, Serpe RT: The prevalence of pathologic skin picking in US adults. Compr Psychiatry 2010;51:183-186.
5. Hayes SL, Storch EA, Berlanga L: Skin picking behaviors: An examination of the prevalence and severity in a community sample. J Anxiety Disord 2009;23:314-319.
6. Gupta MA, Gupta AK, Haberman HF: The self-inflicted dermatoses: a critical review. Gen Hosp Psychiatry 1987;9:45-52.
7. Keuthen NJ, Deckersbach T, Wilhelm S, Hale E, Fraim C, Baer L, O'Sullivan RL, Jenike MA: Repetitive skin-picking in a student population and comparison with a sample of self-injurious skin-pickers. Psychosomatics 2000;41:210-215.
8. Bohne A, Wilhelm S, Keuthen NJ, Baer L, Jenike MA: Skin picking in German students. Prevalence, phenomenology, and associated characteristics. Behav Modif 2002;26:320-339.
9. Odlaug BL, Lust K, Schreiber LR, Christenson G, Derbyshire K, Grant JE: Skin picking disorder in university students: health correlates and gender differences. Gen Hosp Psychiatry 2013;35:168-173.
10. Prochwicz K, Kaluzna-Wielobob A, Klosowska J: Skin picking in a non-clinical sample of young Polish adults. Prevalence and characteristics. Compr Psychiatry 2016;71:77-85.
11. Leibovici V, Murad S, Cooper-Kazaz R, Tetro T, Keuthen NJ, Hadayer N, Czarnowicki T, Odlaug BL: Excoriation (skin picking) disorder in Israeli University students: prevalence and associated mental health correlates. Gen Hosp Psychiatry 2014;36:686-689.
12. Odlaug BL, Grant JE: Clinical characteristics and medical complications of pathologic skin picking. Gen Hosp Psychiatry 2008;30:61-66.
13. Arnold LM, McElroy SL, Mutasim DF, Dwight MM, Lamerson CL, Morris EM: Characteristics of 34 adults with psychogenic excoriation. J Clin Psychiatry 1998;59:509-514.
14. Odlaug BL, Kim SW, Grant JE: Quality of life and clinical severity in pathological skin picking and trichotillomania. J Anxiety Disord 2010;24:823-829.
15. Snorrason I, Smari J, Olafsson RP: Emotion regulation in pathological skin picking: findings from a non-treatment seeking sample. J Behav Ther Exp Psychiatry 2010;41:238-245.
16. Christenson GA, Mackenzie TB, Mitchell JE: Characteristics of 60 adult chronic hair pullers. Am J Psychiatry 1991;148:365-370.
17. Flessner CA, Woods DW: Phenomenological characteristics, social problems, and the economic impact associated with chronic skin picking. Behav Modif 2006;30:944-963.
18. Wilhelm S, Keuthen NJ, Deckersbach T, Engelhard IM, Forker AE, Baer L, O'Sullivan RL, Jenike MA: Self-injurious skin picking: clinical characteristics and comorbidity. J Clin Psychiatry 1999;60:454-459.
19. Association AP: Diagnostic and Statistical Manual of Mental Disorders, ed 5th. Arlington, 2013.
20. Koo JY, Ng TC: Psychotropic and neurotropic agents in dermatology: unapproved uses, dosages, or indications. Clin Dermatol 2002;20:582-594.
21. Deckersbach T, Wilhelm S, Keuthen NJ, Baer L, Jenike MA: Cognitive-behavior therapy for self-injurious skin picking. A case series. Behav Modif 2002;26:361-377.
22. Teng EJ, Woods DW, Twohig MP: Habit reversal as a treatment for chronic skin picking: a pilot investigation. Behav Modif 2006;30:411-422.
23. Flessner CA, Busch AM, Heideman PW, Woods DW: Acceptance-enhanced behavior therapy (AEBT) for trichotillomania and chronic skin picking: exploring the effects of component sequencing. Behav Modif 2008;32:579-594.
24. Schuck K, Keijsers GP, Rinck M: The effects of brief cognitive-behaviour therapy for pathological skin picking: A randomized comparison to wait-list control. Behav Res Ther 2011;49:11-17.
25. Gieler U, Consoli SG, Tomas-Aragones L, Linder DM, Jemec GB, Poot F, Szepietowski JC, de Korte J, Taube KM, Lvov A, Consoli SM: Self-inflicted lesions in dermatology: terminology and classification--a position paper from the European Society for Dermatology and Psychiatry (ESDaP). Acta Derm Venereol 2013;93:4-12.
26. Soomro GM, Altman D, Rajagopal S, Oakley-Browne M: Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). Cochrane Database Syst Rev 2008:CD001765.
27. Simeon D, Stein DJ, Gross S, Islam N, Schmeidler J, Hollander E: A double-blind trial of fluoxetine in pathologic skin picking. J Clin Psychiatry 1997;58:341-347.
28. Bloch MR, Elliott M, Thompson H, Koran LM: Fluoxetine in pathologic skin-picking: open-label and double-blind results. Psychosomatics 2001;42:314-319.
29. Keuthen NJ, Jameson M, Loh R, Deckersbach T, Wilhelm S, Dougherty DD: Open-label escitalopram treatment for pathological skin picking. Int Clin Psychopharmacol 2007;22:268-274.
30. Kalivas J, Kalivas L, Gilman D, Hayden CT: Sertraline in the treatment of neurotic excoriations and related disorders. Arch Dermatol 1996;132:589-590.
31. Gupta MA, Gupta AK: Olanzapine is effective in the management of some self-induced dermatoses: three case reports. Cutis 2000;66:143-146.
32. Christensen RC: Olanzapine augmentation of fluoxetine in the treatment of pathological skin picking. Can J Psychiatry 2004;49:788-789.
33. Lee CS KJ: Psychotropic agents. . Comprehensive Dermatologic Drug Therapy, 2nd ed, Wolverton SE (Ed), Elsevier, London 2007;2:402.
34. Grant JE, Odlaug BL, Chamberlain SR, Keuthen NJ, Lochner C, Stein DJ: Skin picking disorder. Am J Psychiatry 2012;169:1143-1149.
35. Odlaug BL, Grant JE: N-acetyl cysteine in the treatment of grooming disorders. J Clin Psychopharmacol 2007;27:227-229.
36. Grant JE, Chamberlain SR, Redden SA, Leppink EW, Odlaug BL, Kim SW: N-Acetylcysteine in the Treatment of Excoriation Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2016;73:490-496.
37. Miller JL, Angulo M: An open-label pilot study of N-acetylcysteine for skin-picking in Prader-Willi syndrome. Am J Med Genet A 2014;164A:421-424.
38. Oliver G, Dean O, Camfield D, Blair-West S, Ng C, Berk M, Sarris J: N-acetyl cysteine in the treatment of obsessive compulsive and related disorders: a systematic review. Clin Psychopharmacol Neurosci 2015;13:12-24.
39. Paydary K, Akamaloo A, Ahmadipour A, Pishgar F, Emamzadehfard S, Akhondzadeh S: N-acetylcysteine augmentation therapy for moderate-to-severe obsessive-compulsive disorder: randomized, double-blind, placebo-controlled trial. J Clin Pharm Ther 2016;41:214-219.
40. Deepmala, Slattery J, Kumar N, Delhey L, Berk M, Dean O, Spielholz C, Frye R: Clinical trials of N-acetylcysteine in psychiatry and neurology: A systematic review. Neurosci Biobehav Rev 2015;55:294-321.
41. Spiegel DR, Finklea L: The recognition and treatment of pathological skin picking: a potential neurobiological underpinning of the efficacy of pharmacotherapy in impulse control disorders. Psychiatry (Edgmont) 2009;6:38-42.