What Are the Lesions on This Woman’s Chin?
David L. Kaplan, MD—Series Editor
Kaplan DL. What are the lesions on this woman’s chin? Consultant. 2016;56(10):906,908.
This 62-year-old woman presented for evaluation of lesions confined to her chin that had only appeared over the past 8 months. She was taking amphetamine-dextroamphetamine, 80 mg daily, for adult attention deficit/hyperactivity disorder (ADHD) and was otherwise healthy.
What are the lesions on this woman’s chin?
- Acne excoriee
- Staphylococcal folliculitis
- Hirsutism with ingrown hairs
- Demodex folliculitis
Answer and discussion on next page
Answer: Acne excoriee
This patient was felt to have a compulsion to pick and excoriate her skin, and her condition could be termed acne excoriee. This condition has been associated with stress, depression, and anxiety.1 It was felt that her ADHD medication could be exacerbating her feelings of anxiety, and it was recommended that she try to decrease her dose of medication if that was acceptable to her prescribing physician. It was also recommended that she seek evaluation for possible underlying psychological factors that could be contributing. Some patients also benefit from acrylic nails, which prevent them from effectively excoriating their skin. Some resourceful patients have resorted to instruments such as tweezers and needles, which only worsens the condition.
David L. Kaplan, MD, is a clinical assistant professor of dermatology at the University of Missouri–Kansas City School of Medicine in Kansas City, Missouri, and at the University of Kansas School of Medicine in Kansas City, Kansas. He practices adult and pediatric dermatology in Overland Park, Kansas.
1. Leibovici V, Koran LM, Murad S, et al. Excoriation (skin-picking) disorder in adults: a cross-cultural survey of Israeli Jewish and Arab samples. Compr Psychiatry. 2015;58:102-107.