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A report describes a case of a 23-year-old female with excoriated papules and shallow ulcers on the face. She had a history of mild facial acne for several years. She utilized various nonprescription measures for her acne and also reported a meticulous skincare routine.
She agreed to remove the lesion by squeezing or cleaning it with her fingers, tweezers, using magnifying mirror, etc. She had anorexia nervosa and weighed 37 kg. She also had amenorrhea; with only two episodes of menstruation to date. No other health issues were reported.
On the first visit, she was counseled and reassured that her condition was a result of a meticulous skin cleaning regimen and removing the lesions. She was directed that this condition might be a purely psychological or even psychiatric issue, in an indirect way. She was also informed that any scratched or picked lesions take longer to heal and thus was guided not to touch the lesions.
She was explained all possible therapeutic measures for mild-to-moderate acne, including topicals, laser and systemic therapies, for which she agreed on the topical therapy and laser. Azelaic acid cream bid and fusidic acid cream bid were prescribed along with carrying out a series of therapies with a 1,064 nm Nd:YAG laser.
She was given 6 laser sessions, once every 2 weeks. Each session included 3 full-face passes with 40-45 J/cm². After 2 sessions, each session relieved the existing lesions and reduced the severity of new outbreaks. After 2 months, there was complete remission with only a few residual hyperpigmentations, which faded eventually. She is still in remission and follow-up after 3 years and continues to use azelaic acid cream daily.
Source: Tlaker V. Successful therapy of excoriated acne with Nd:YAG laser: a case report. Acta Dermatovenerol Alp Pannonica Adriat. 2017;26(3):73-5.