"Pickers" Acne Scars

“Skin pickers” acne scars are very different scars. They are not ice picks, boxes, or rolling scars. These are the result of an intense, uncontrollable urge to squeeze and pick at the skin. Repeated picking at one’s own skin results in Picker Scars. They are also known as excoriated acne scar.

Excoriated acne is associated with a compulsive disorder. Squeezing the occasional pimple isn’t considered excoriated acne — it occurs only when the habit becomes constant and uncontrollable.  A psychological consultation is advised to prevent the possibility of future scarring.

Wound care may help prevent such scars forming, however, once formed, no type of creams, lasers or other non-surgial treatments will be of value. Untreated, these scars and unhealed areas will persist or even worsen over time.

 

These scars are classified by their lack of skin appendages, the specialized skin structures located deeper in the skin which may be either hair follicles, oil glands called sebaceous glands, or sweat glands. These structures give the skin its texture and a normal ability to heal.

Why are these scars different?

These scars are completely white because the melanin producing cells are no longer present because they were destroyed by infection.  These scars are completely flat, smooth, with no similarity to normal surrounding skin. They are simply a thin layer of epidermis with collagen (scar) below. There are no pores or evidence of sweat glands or Hair follicles and are difficult to cover with makeup.

The treatment of such scars varies dramatically from the treatment of other types of acne scar. Rolling scars, for example, may have increased pigmentation and evidence of pores or sweat glands remaining. These scars can be treated from below and expected to heal properly.

Will laser or peeling help?

Once these scars are formed, there is no benefit to medicated creams, gels, injections, chemical peel, dermabrasion, laser therapy, or micro-needling. All such treatments can only worsen the problem and will be of no benefit. Any type of laser, “peel”, or “needling” is contraindicated because these scars do not have a normal ability to heal. Hair follicles and glands are required to provide the cells required for healing. They are also known excoriated acne scar.

When possible, excision or cutting the scar out is often the best option. The large scarred area is removed and traded for a much smaller, fine, straight-line scar. This is performed under local anesthesia in an office operating room.

In some cases, the scars are so large that they cannot be removed entirely in one visit. Such excision is best left to the expertise of a plastic surgeon experienced with the principles of “staged excision”(see image). Staged or serial excision is a basic plastic surgery principle in which part of the scar is removed surgically and after a period of several months, the remainder of the scar can be removed in a second procedure. It is important that such elective incisions be placed in what are called elective lines of incision, well-known to plastic surgeons, in order for the patient and surgeon to obtain the best scar possible.  In some cases, when depigmentation is present, cosmetic tattooing may be of benefit.

Why does this happen?

Excoriated acne is associated with a compulsive disorder. Squeezing the occasional pimple isn’t considered excoriated acne. It occurs only when the habit becomes constant and uncontrollable.  A psychological consultation is advised to prevent the possibility of future scarring.