EIt is not often that dermatologists and psychiatrists deal with an illness together. However, this makes sense for knee acne. People who forcibly maltreat pimples, hairs or crusts on the face or arms with fingers, tweezers or needles until blood comes out have more than just one skin problem: they are usually also emotionally wounded.
The name “Acné excoriée des jeunes filles” (“scratchy acne in young girls”) is due to the French doctor Louis Brocq, who was the first to describe the phenomenon in 1898. The repeated, sometimes compulsive pounding around even the smallest pimples and bumps is to be found especially in girls and young women and usually leads to an aggravation of the skin changes. Men rarely suffer from it.
Studies in the US show that 1.4 to 5.4 percent of the population is affected. The disease can occur at any time, but it is particularly common in late childhood or early adolescence. Surprisingly, there is a second frequency peak in 30 to 45 year old women.
The unobserved moment
The “acné excoriée” is an overreaction to actual or imagined skin changes on the face, explain the professors Alexander Navarini, senior physician at the dermatological university clinic Zurich, and Undine Lang, director of adult psychiatry at the university psychiatric clinic in Basel. People are usually pounded and tickled when the person concerned is alone or feels unobserved.
Constant checking and tingling can become an addiction
Quelle: Getty Images
The obsessive-compulsive binge is referred to as “Skin Picking Disorder” according to the American-English nomenclature DSM-5 (the “Diagnostic and Statistical Manual of Mental Disorders”, a classification system for mental disorders) and has been an independent disease from the group of obsessive-compulsive disorder since 2015 .
“Your own skin is examined centimeters in front of the bathroom mirror or even with the help of a magnifying glass and an attempt is made to clean it in a pathological way, either with your fingers or with tools. Wounds that have not yet healed are torn open again, scratched, plucked, squeezed and sometimes tools are used, which can lead to painful complications, bleeding and inflammation ”, say the experts.
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Dealing with the skin can take anywhere from minutes to several hours. “As with obsessive-compulsive disorder, patients spend a lot of time working on their skin lesions and know that what they are doing is futile, but they cannot stop,” said Navarini and Lang. Mainly areas of skin around blemishes such as pimples or blackheads are processed, often in a trance or ecstasy-like state. Insect bites, infections, wounds, scars or birthmarks can also be pressed, scratched or squeezed.
Acné excoriée is very similar to addictions, and those affected are aware that it is harming themselves. In this country, acné excoriée is also called dermatotillomania – based on trichotillomania (plucking your own hair). However, these terms are misleading because it is not a “mania” in the psychiatric sense.
Important clues to the diagnosis include the inability to resist the temptation to perform a self-harming act; the feeling of pleasure, satisfaction or relaxation during the tingling and shame, remorse, self-reproach or guilt after the performed action.
Valve for inner tension
The tingling serves as a valve for internal tension. The triggers for a nibbling attack are often emotional events: The tingling sensation can be triggered both by negative emotions such as anger about an insult, grief because of a separation, stress, nervousness, tension, frustration or excessive demands, as well as by positive feelings such as joy or curiosity. Boredom or emptiness can also have a triggering effect.
The advice to “just keep your hands off it” does not help those affected: they know that their habits are harming themselves, they are ashamed and reproach themselves. But insight and reason are mostly ineffective: Once the self-harming behavior has taken hold, it is not possible to stop overnight.
Most of those affected do not like to hear recommendations to seek psychotherapeutic advice and instead seek dermatological treatment for their disorder. Medicines that are commonly used to treat acne, such as benzoyl peroxide, antibiotics or retinoids, are usually useless in treating acne excoriée. “The treatment must rather try to minimize the self-inflicted damage and adapt behavior,” emphasize Navarini and Lang.
For treatment, behavioral therapeutic procedures, relaxation techniques and the use of specific psychotropic drugs have proven to be promising. With behavior therapy, those affected train to better control their behavior. In cases of stress, tension, anger, and frustration, patients should learn to consciously reduce tension in order to avoid a flare-up of dermatotillomania.
This article was first published in 2017.
Self-help groups and relevant portals on the Internet provide useful information from those also affected – for example: www.skin-picking.de
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