Acne excoriee is predominantly a disease of females. Usually the acne is mild but most of the lesions are attacked by the patient producing large areas of inflammation with crusting  .  The face is commonly affected. The  dividing line between acne excoriee and neurotic excoriations confined to  the face is tenuous. Virtually all patients with acne excoriee have a psychiatric disorder - in particular an obsessional trait or depression.

  In a study of eight women who  had suffered from excoriations on the face only, which had persisted for up  to twenty  years, psychiatric investigation showed that in a large proportion the excoriations were used as a protective device to conceal an emotional failure. The women  were found not to respond to dermatological treatment.  Improvement in the dermatosis after treatment with  phenothiazines and psychotherapy revealed in many a  phobic state which had previously been hidden even from the patient.

  This  author's experience is based on  patients who have had the disease for less than ten years and usually less than five years; such patients respond reasonably well to  therapy. However few the number of lesions, oral treatment with 1 g/day of tetracycline is required topical therapy is not well tolerated.

  It is  likely that  those  patients with definite  acne lesions which are secondarily  excoriated will respond to acne  therapy  whereas  those with   primary neurotic excoriations will not.