Psychosomatic study of self-excoriative behavior among male acne patients: preliminary observations.

BACKGROUND Studies of the psychosomatic correlates of self-excoriative behavior in acne have involved mainly women with acne excorieé. Little is written about the psychosomatic factors that affect men with acne. Excessive self-excoriation of acne lesions is an important clinical factor because it can prolong the course of the disease and exacerbate the deeper inflammatory process with an increase in the severity of scarring. METHODS Thirteen men (mean +/- SE: age: 22.2 +/- 1.4 years) with mild to moderate facial acne, whose self-excoriative behavior was not severe enough to result in acne excorieé, completed a battery of self-rated questions assessing their self-excoriative behaviors, the severity of their acne, and various psychologic factors. RESULTS Certain aspects of self-excoriative behavior (e.g., a tendency to pick or squeeze the acne lesions when stressed) correlated directly with depression (brief symptom inventory (BSI)) (Pearson r = 0.64, P = 0.02) and anxiety (BSI) (Pearson r = 0.61, P = 0.03) scores. The dermatologic indices of acne severity such as inflammation (Pearson r = 0.82, P = 0.0004) and pustules (Pearson r = 0.62, P = 0.03) were the strongest correlates of self-excoriative behavior. CONCLUSION Self-excoriative behavior in men with acne may be exacerbated by a coexisting depressive or anxiety disorder. In contrast, women with acne excorieé have been reported to suffer from an immature personality where the cutaneous condition may serve as "an appeal for help." Men who excessively pick their acne will benefit from aggressive dermatologic therapies and should be assessed for underlying depressive and anxiety disorders.