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We’ve all been there—standing in front of the mirror, that one pimple staring back at you, practically begging to be picked. You’re just going to „help it along.“ It will make things better. Help it clear faster, right? Wrong. Picking your acne will always make it worse and increase the risk of acne scars and hyperpigmentation. And we all know that. But what if even though you know, you simply can’t stop picking at your skin? If your acne isn’t that bad at all, but you are left with scars and sores that never seem to heal because you simply can’t keep your fingers from squeezing, tugging and twisting your skin?

 

 

Then, my friend, you might suffer from Acne excoriée or picker’s acne, a form of acne belonging to the dermatillomania family. It is is more than just a fancy term for overzealous skin picking. It’s actually a psychological disorder where the urge to pick at even the smallest skin imperfections becomes overwhelming, often leading to scarring and prolonged skin issues. Unlike the occasional pimple pop (no judgment here—I get it), Acne excoriée can involve hours spent in front of the mirror, picking at blemishes that aren’t even ready to be touched. The result? Redness, scabs, scars, and a sense of frustration that can be hard to shake. Let’s talk about what causes it and what you can do to finally stop before you are left with scars for a lifetime.

 

 

What is Acne excoriée and Dermatillomania?

Acne excoriée is a specific form of a broader condition known as dermatillomania, or skin-picking disorder. Dermatillomania is a mental health condition where a person compulsively picks or scratches their skin, causing injuries or scarring.

The name comes from „Derma“ – skin – „Tillo“ – pulling or picking – and „Mania“ – an excessive behavior or activity“ It is often grouped under the category of obsessive-compulsive disorders (OCDs) but has some key differences:

• Obsessions: Unlike OCD, which involves persistent, unwanted thoughts (obsessions) that create anxiety, dermatillomania doesn’t typically involve these uncontrollable thoughts or urges.
• Feeling of Reward: People with dermatillomania often feel relief or even satisfaction after picking at their skin, whereas OCD behaviors don’t provide that kind of positive reinforcement.
• Self-Injury: Dermatillomania involves self-damage, which is not typical for OCD.

Another category it is often grouped under are the Self-Inflicted Skin Lesions (SISL), a terminology introduced by the European Society of Dermatology and Psychiatry in 2013. SISL can be defined as any skin lesion actively and directly produced by the patient on his/her skin, mucosa or integuments that is not better explained as a consequence of another physical or mental disorder

Acne excoriée typically appears in females during adolescence or young adulthood and can cause significant disfigurement and psychosocial impairment. Men can be affected too, but depending on the population studied the ratio female to male is between 3:1 up until 20:1. The condition often involves picking at real or imagined blemishes, which can lead to scarring, hyperpigmentation, and increased acne lesions, but, and that is very important, can also occur when basically no acne is present and perceived lesions that could potentially turn into a clogged pore are squeezed and scratched and manipulated until they become a red, open wound.

 

 

Where is the line between occasionally popping a pimple and having acne excoriee?

If I was a gambler – I am very much not! – I would bet money that you have at some point in your life picked at a spot until it was way worse than it was before. I know I have, more than once, and I have small marks on my face that I attribute to that. And yes, I knew while doing it that I was making things worse, and still went on and on and on. But I don’t suffer from acne excoriee, and neither do you if you do pop a pimple occasionally.

If the constant picking at your skin feels like something you can’t control though, if it takes up hours of your free time hindering you from doing stuff you’d actually enjoy or if it stops you from going to social events, school or work – basically if it lowers your perceived quality of life and you suffer, then you might have crossed the line. I say might because there barely ever is a sharp line between black and white, but instead a large grey area. A spectrum, if you will.

 

 

But why do we pick at our skin?

Now if we know something is bad for us, why do we do it? A great, almost philosophical question.

The urge to pick at our skin can come from a variety of places—stress, anxiety, boredom – it usually is more than just the desire to have „perfect“ skin. For those of us with perfectionist tendencies, that little bump or spot might feel like an intolerable flaw, something that needs to be fixed right away.

The problem is, the more we pick, the more we irritate our skin, and the more imperfections we create. It’s a vicious cycle that’s not just hard on your skin but can be really tough on your mental well-being too.

Picking can happen in two main ways:

• Automatic Picking: You pick at your skin without even realizing it, probably deep in thought, watching tv, scrolling Instagram or reading. Often you’ll start running your hands over your face and neck until you feel a tiny, maybe even invisible irregularity and then start. I have one spot where a stiff hair will grow, right here, and I often find myself testing this area with my finger unconsciously to see if it is reemerging after I tweezed it. And if it does, I will keep manipulating until I notice and get up to tweeze it again.
• Focused Picking: Focused picking often starts when you are in front of a mirror or even worse, a magnifying mirror, and are able to closely examine your skin. You zoom in on soon to be blackheads, scabs, tiny whiteheads and then start. This process can take hours and even involve tools like extractors or needles, leading to even more damage and a very high likelihood for scarring.

As something considered part of the obsessive-compulsive spectrum it is linked to anxiety and impulse control. It’s not just about wanting clearer skin; it’s about feeling compelled to do something that, deep down, you know isn’t actually helping. Picking provides a temporary sense of relief—a way to control something in the moment—but the long-term damage can be significant. And while the scars on your skin are visible, the impact on your confidence can be even harder to heal.

 

 

How does Acne excoriée affect your life?

Picking can create new wounds or reopen old ones, leading to bleeding, scarring, and, in severe cases, infections that require medical intervention. While Acne excoriee is usually limited to the face and maybe neck, dermatillomania can affect all areas that are easily accessible, think forearms, fingers, hands, and even involve pulling out your hair or lashes, a condition called Trichotillomania.

Beyond the physical damage, dermatillomania can also have a significant mental health impact. People with this condition often feel embarrassed or ashamed of their visible injuries and may try to hide them with clothing or makeup. This can lead to anxiety, depression, and social isolation, further impacting quality of life.

 

 

So what can you do to stop picking?

If this all sounds a bit too relatable, don’t worry, you’re not alone. Up to 5% of the population has been affected at some point in their lives, and many are able to break the cycle and stop.

Here are some tips that might help, but before I go on and list them: You can’t just will your way out of a mental health problem. Not out of depression, not out of anxiety and not out of compulsive skin picking. As soon as you realize that these simple tips don’t cut it for you, don’t hesitate to seek professional help. Your dermatologist is a great first contact, but the issue usually requires a multi professional approach including seeing a therapist.

1. Keep your hands busy: I know, easier said than done. But especially if you do automatic picking, anything that will keep your hands from wandering all over your face is a win. Fidget toys for example, or stress balls, maybe even knitting – anything that works for you.
2. Hydrocolloid Patches: If you feel a spot coming up or even if you have already picked at it, put a pimple patch over it. This not only increases a better environment for healing, but also a physical barrier between the spot and your fingers – you can manipulate the patch, but not the skin underneath. (More info: Pimple patches to help heal the skin)
3. Stay away from your mirror: Like seriously, especially the magnifying ones. The closer you look at your skin, the more imagined imperfections you will see, and the bigger the urge will become to having a go at them. Now that doesn’t mean doing your makeup in the dark, but practice looking at your reflection with compassion rather than the critical eye we usually adapt.
4. Treat your acne: Just to be clear: Acne excoriee will not go away magically when your acne is gone. Depending on the underlying cause, you don’t stop picking when there are no more lesions to pick at as the compulsive component doesn’t vanish. You will just pick until there is a new lesion. But in mild cases, getting the acne under control will contribute greatly to your ability to resist the urge to pick. (More info: Why you have pimples – acne basics and treatment explained)

But again, sometimes the urge to pick is too strong to tackle alone, and that’s okay. Talking to a dermatologist or therapist can provide you with strategies and support to manage the picking, so don’t hesitate to ask for help.

 

TL;DR

Dermatillomania, also known as skin-picking disorder, involves compulsive picking at your skin, often leading to scarring and emotional distress. Acne excoriée is a related condition focused on acne lesions. These behaviors are often driven by stress, anxiety, or perfectionism and can be challenging to control. Breaking the cycle may require practical strategies like avoiding mirrors, using patches, and seeking professional help to prevent lasting skin and mental health impacts.

 

 

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