Casual Comments by DJ Elpern
Abstract: Many young women habitually pick facial lesions which in reality may be rather minor. These are some informal thoughts on excoriated acne with a suggestion of a simple behavioral technique called “mirror amputation” that may help some of these persons.
Keywords: acne, excoriations, acne excorie de jeunes filles, dermatotillomania, mirror amputation, skinorexic
Dermatologists see women with excoriated acne regularly. The typical patient is a young to middle-aged woman with scattered excoriations on the face. There is a surprisingly scant literature on this common disorder which has also been called acne excoriee de jeunne filles (AEJF), Dermatotillomania, and Skinorexia.
A recent post on AEJF on the blog Well+Good, is a helpful introduction to this area. Many young women have a “tendency to pick at imperfections where none really exist. We all get pimples, but these clients can’t leave them alone. This behavior is surprisingly common, and afflicts up to one-third of the population, mostly women in their teens, 20s and 30s, says Hadley King, MD, a dermatologist with Day Cosmetics Laser & Comprehensive Dermatology. Called dermatillomania or acne excoriée des jeunes filles (loosely translated as “acne scratching by girls”), pore tampering is rooted in psychology—but inflicts its trauma on the skin, often the face.” [It’s unclear to me if there is documentation that one-third of the population has this behavior, but one commonly sees these patients in a dermatology practice. DJ Elpern]
It is important for the practitioner to ascertain what is going on in the patient’s life. Ask, and she will tell you. Most patients with AEJF have a psychogenic component that drives the picking, tweezing or excoriating. Often, the signs of acne vulgaris in these patients are mild or sometimes even non-existent. The psychogenic component may require counseling, but a simple behavioral strategy (Mirror Amputation) may be all that is needed.
Years ago, in a long discarded throwaway journal, I came across the term “Mirror Amputation” for Acne Excoriee. Simply stated, this means that the patient with AEJF should stay an arm’s length away from a mirror. If she does that, she will not be able to see the minor imperfections well enough to pick or tweeze them. “Mirror Amputation” is a simple behavioral trchnique that can be effective for many patients with AEJF.
For a disorder that is so commonplace, it is surprising how has been written there is on this subject. There’s an old phrase from F.W. Peabody’s classic article “The Care of the Patient” that is appropriate for patients with AEJF: “Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine… for the secret of the care of the patient is in caring for the patient.”