Treatment of Facial Scarring and Ulceration Resulting from Acne Excori»e with 585-nm Pulsed Dye Laser Irradiation and Cognitive Psychotherapy

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Treatment of Facial Scarring and Ulceration Resulting from Acne Excori»e with 585-nm Pulsed Dye Laser Irradiation and Cognitive Psychotherapy
June 2004
To cite this article: Leyda E. Bowes MD, Tina S. Alster MD (2004)
Treatment of Facial Scarring and Ulceration Resulting from Acne Excori»e with 585-nm Pulsed Dye Laser Irradiation and Cognitive Psychotherapy
Dermatologic Surgery 30 (6), 934Ò938.
doi:10.1111/j.1524-4725.2004.30266.x
Blackwell Synerg

Leyda E. Bowes, MD*
*Washington Institute of Dermatologic Laser Surgery, Washington, DC, and Tina S. Alster, MD**Washington Institute of Dermatologic Laser Surgery, Washington, DC

Address correspondence and reprint requests to: Tina S. Alster, MD, Washington Institute of Dermatologic Laser Surgery, 2311 M Street, NW, Suite 200, Washington, DC, or e-mail: talster@skinlaser.com.
LEYDA E. BOWES, MD, AND TINA S. ALSTER, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS.

Abstract
Background. Self-inflicted skin ulcers and scars are often observed in patients with compulsive skin picking. The term "neurotic excoriation" has been used to describe this condition and may or may not coexist with other true skin pathologies, such as acne. The condition poses a diagnostic and treatment challenge because patients often also have an undiagnosed underlying psychologic disorder.

Case reports. Two patients with numerous linear and stellate facial ulcers and hypertrophic and erythematous scars were diagnosed with acne excori»e in the setting of an obsessive-compulsive disorder linked to emotional stress and anxiety. The scars were treated with a 585-nm flashlamp-pumped pulsed dye laser using a 7-mm spot size, 1.5-msec pulse duration, and fluence range of 4.5 to 6.0 J/cm2. The patients received concomitant cognitive psychodynamic therapy to halt the cycle of impulse-driven skin picking and ulcer/scar formation. Marked clinical improvement of the scars and successful treatment of the acne excori»e were achieved with this combination approach. Relapses occurred when psychodynamic intervention was interrupted.

Conclusion. The 585-nm flashlamp-pumped pulsed dye laser improves the appearance of hypertrophic erythematous facial scars and ulcers in patients with severe acne excori»e. Proper diagnosis of underlying impulse-control disorders and ongoing psychodynamic therapy is necessary to maintain improvement.

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