Integrated CO 2 Laser Treatment and Cognitive–Behavioral Therapy for Postadolescent Acne Excoriée: Clinical Outcomes From a Case Series

TL;DR

Combining laser treatment and therapy helps manage severe acne in adults by targeting both skin damage and compulsive behavior.

Contribution

A novel combined approach using CO2 laser and CBT for postadolescent acne excoriée is proposed and tested.

Findings

All patients showed rapid and sustained clinical improvement.

The treatment disrupted the cycle of skin injury and inflammation.

CO2 laser and CBT together address both physical and psychological aspects of the condition.

Abstract

Self‐inflicted skin injury is a significant yet often underrecognized contributor to acne progression, particularly in postadolescent populations. It not only perpetuates lesions but also triggers inflammatory cascades, including sebaceous gland epithelialization and cystic transformation. Postadolescent acne excoriée poses unique therapeutic challenges due to the interplay of dermatological and psychological factors.

To evaluate the effectiveness of a combined psychodermatological treatment—CO2 laser ablation and cognitive–behavioral therapy (CBT)—in managing chronic, treatment‐resistant postadolescent acne excoriée.

A case series of three patients with refractory postadolescent acne excoriée was conducted. Treatment involved CO2 laser ablation to remove obstructed sebaceous glands, combined with CBT targeting maladaptive excoriation behaviors.

All patients achieved rapid and sustained clinical improvement. The combined approach disrupted the pathomimetic cycle, eliminated visible obstructed sebaceous glands, and reduced compulsive skin manipulation.

Integrating CO2 laser ablation with CBT offers a dual benefit of addressing both the physical lesions and psychological drivers of acne excoriée. Multidisciplinary collaboration is essential for effective management of complex psychocutaneous disorders.

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