Acne Excoriée (Excoriated Acne): Specialist Diagnosis & Treatment in London

What Is Acne Excorie (Acne excoriée)?

Acne excorie, often written as acne excoriée, describes acne that has been excoriated — picked, scratched or squeezed — leading to open sores, scabs, delayed healing and more noticeable marks. Many people do this automatically when anxious, stressed or focused in front of a magnifying mirror. Others pick in hopes of “fixing” a tiny bump that nobody else would see. The result is the opposite: more inflammation, a higher chance of infection, and a longer pathway to clear skin.

This condition is common yet under-discussed. It can affect anyone with acne-prone skin and is particularly distressing because the picking behaviour itself becomes part of the cycle. The good news: with a calm, non-judgemental plan that targets both acne control and picking triggers, skin can heal and confidence can return.

How Acne Excorie Develops

Most people with acne excorie start with ordinary acne lesions — blackheads, whiteheads and inflamed spots. Touching and squeezing breaks the surface, creating a raw area or “erosion”. The body makes a protective scab, which can be itchy or rough. If that scab is removed early, a new scab forms and the cycle continues. Each cycle delays closure of the wound and increases the risk of pigmentary change (redness or dark marks) and scarring. Because the barrier is broken, bacteria can enter more easily, leading to secondary infection that requires antimicrobial care.

Psychological factors commonly contribute. Skin picking may be a form of body-focused repetitive behaviour (BFRB) — an automatic or intentional action that provides brief relief or a sense of “tidying”. Stress, fatigue, perfectionism, boredom, screen time and magnifying mirrors all increase risk. Understanding personal triggers is pivotal to recovery.

Typical Signs and Patterns

• Multiple small sores or excoriations at different healing stages, often on the face (cheeks, chin, forehead), chest or back.
• Crusts and scabs that reform after being picked off, and tender raw areas.
• Post-inflammatory erythema (red marks) or post-inflammatory hyperpigmentation (brown/grey marks), particularly in skin of colour.
• Occasional secondary infection with increased pain, honey-coloured crusts or pus.
• Emotional distress, embarrassment, or avoiding social events because of visible lesions or fear of picking.

Assessment at Your Visit

Your clinician will map out which lesions are primary acne and which are secondary to picking. We discuss when picking happens (evening, mirrors, work calls), what feelings precede it (stress, boredom, relief-seeking), and which tools or situations make it worse (magnifying mirrors, bright task lighting, tweezers, nail edges). You will never be blamed; the aim is to understand your pattern so we can build a plan that is kind, realistic and effective.

Our Treatment Approach

Improvement comes from tackling three fronts together: gentle acne control, wound-friendly healing, and behavioural support to reduce picking urges. We also plan for scar prevention and post-inflammatory colour change, which are key concerns for many people.

1) Gentle, Evidence-Based Acne Control

• Cleanse with a mild, fragrance-minimal cleanser morning and night; cleanse after sport or heavy sweat.
• Target with well-tolerated actives: a retinoid to normalise pores and reduce new comedones; benzoyl peroxide for antibacterial action; azelaic acid to calm redness and even tone. We introduce actives gradually to minimise irritation that could tempt picking.
• Moisturise daily with non-comedogenic hydrators to support barrier repair and reduce stinging.
• Sun protection every morning. UV darkens marks and slows healing; broad-spectrum SPF helps even skin tone over time.
• Short courses of oral medicines may be used in specific flares (for example, if infection is suspected or inflammation is severe). We prefer measured, time-limited use with a clear exit plan.

2) Wound-Friendly Healing & Infection Control

• Hands off, heal on: once the surface is broken, squeezing never speeds healing. We protect the area and let skin cells knit together.
• Occlusion for comfort: simple petrolatum-based ointments or hydrocolloid dressings can reduce irritation and discourage touching. Dressings are used selectively on body sites where practical — our skin texture care guidance covers usage.
• Signs of infection: increasing pain, spreading redness, warmth, honey-coloured crusts or pus merit prompt review. A short targeted antimicrobial may be needed — we can confirm with a skin swab test or fungal testing if indicated.
• Itch control: bland emollients and cool compresses help; we avoid harsh scrubs or picking off scabs.

3) Behavioural Support to Reduce Picking Urges

Acne excorie improves fastest when picking urges are addressed compassionately. We use practical, psychology-informed steps:

• Stimulus control: remove magnifying mirrors; soften bathroom lighting; set “mirror distance rules” so you view your face from a normal distance; cover sharp nail edges.
• Habit-reversal strategies: identify your earliest picking cues and substitute a competing response (e.g., clench a stress ball, sit on hands for one minute, hold a cold compress). Even 60–90 seconds lets an urge pass.
• Barrier cues: place hydrocolloid patches or thin dressings on “danger zones” during high-risk times (late night TV, long calls).
• Routine resets: anchor skincare to existing habits (after brushing teeth) to lower friction and maintain momentum.
• Support & stress: sleep, movement and breath work reduce baseline tension. If picking feels compulsive or linked to low mood or anxiety, we can discuss psychodermatology input.

Skin of Colour Considerations

In medium to deep skin tones, post-inflammatory hyperpigmentation (PIH) can last longer than the original spot. This makes “hands off” doubly important. Pigment-safe approaches — sun protection, azelaic acid and gentle retinoids — are prioritised. Any in-clinic procedures are paced and chosen with caution to minimise further pigmentation; see our options for hyperpigmentation treatment.

Scar Prevention & Management

Repeated trauma increases the risk of atrophic (pitted) scars and, on the chest/back, thicker or raised scars. Early steps matter: do not pick scabs; treat infection promptly; consider intralesional therapy for tender, raised areas when appropriate; and use silicone-based topical care on early thickened scars once the surface has healed. Later, texture-refining procedures can be timed carefully once picking is controlled — learn about our acne scar treatments.

Everyday Toolkit

• Keep nails short and smooth; avoid tools (tweezers, extractors) at home.
• Place mirrors at arm’s-length height; avoid magnifying mirrors.
• Use scheduled “check times” rather than frequent mirror visits.
• Keep a brief urge log: note time, trigger, body site, and the alternative you tried. Small wins add up.
• Prepare your workstation: lip balm, hand cream and a stress object keep hands occupied.
• Shower after exercise; change out of sweaty clothing to reduce friction and follicular irritation.

Timelines & Expectations

With a combined plan, the cycle usually begins to break within weeks: fewer new open areas, calmer skin, and fading of fresh marks. Colour change and texture improvements continue over months. Setbacks can happen during stress; that is normal. We plan review points, refresh strategies and keep momentum going. The aim is not perfection but steady, sustainable progress.

When to Seek Prompt Help

• Rapidly worsening pain, heat or swelling suggesting infection.
• Multiple tender lumps under the skin or feverish symptoms.
• Significant distress, low mood or a sense that picking is out of control.

Early contact prevents complications and keeps recovery on track.

Why Choose Skinhorizon?

We combine advanced dermatology with a respectful, practical approach to behaviour change. Plans are personalised to your skin type, lifestyle and goals, with clear guidance on products, procedures and day-to-day strategies that actually fit real life. You will know what to do, why you are doing it, and how to handle wobbles without losing momentum.

Your First Visit — What to Expect

1. Assessment: map acne vs. excoriated lesions; identify triggers and high-risk times.
2. Plan: gentle acne control + wound-friendly healing + behavioural toolkit — see clinic pathways for acne & folliculitis treatment.
3. Aftercare: concise written steps for morning/evening routines and what to do during urges.
4. Review: scheduled follow-up to measure progress, refine actives and adjust strategies.