Integrative approach to treating excoriated acne Conglobata: Navigating Psychodermatology and Liaison Psychiatry in Patient Care

Acne conglobata is a rare and severe form of acne vulgaris, marked by the presence of comedones, papules, pustules, nodules, and at times, hematic or meliceric crusts. Acne excoriée describes a self-inflicted condition where the patient compulsively picks at real or imagined acne lesions. A case brought to our attention involved a 20-year-old Caucasian female patient hospitalized in the dermatology department. As the psychiatry resident on call, I was paged to evaluate her within the liaison psychiatry framework. She presented with erythematous, edematous plaques covered by pustules and crusts on her face. The anamnesis revealed a recent depressive state triggered by the end of a romantic relationship, leading to her scratching and picking at the lesions. The patient’s depressive state, noted before the aggravation of her dermatological symptoms, likely intensified her condition. This psychological distress may have instigated the skin picking, which in turn, could have compromised the response to standard dermatological care. The self-excoriative behavior might also be interpreted as a call for help, as assessed during the psychiatric consultation.