This sense of excoriate is based on its original, literal meaning: to strip off or remove the skin from an animal or person. The skin on your hands might be excoriated from hard yard work, for example.
Excoriated acne is a difficult challenge in daily practice. Patients generally fail to follow the most important measure: not to "clean" and manipulate their lesions. Because the literature tends to emphasize the mental aspect of this condition, patients with excoriated acne may be quickly classified as psychosomatic or even psychiatric cases, and dermatologists may be overlooking opportunities to help. This report presents the case of a young woman with excoriated acne and anorexia nervosa, treated with a combination of 1,064 nm Nd:YAG laser, standard acne topical therapy, and a reassuring, non-judgmental approach. The therapy resulted in complete remission after 2 months, which has remained stable during 3 years of follow-up.
excoriated
The differential diagnosis includes delusional parasitosis, EPS, perforating folliculitis, and prurigo nodularis. Delusional parasitosis also can be characterized by excoriated plaques and a sensation of parasites infesting the skin, as our patient described.10 However, it can be differentiated from RPC by the fact that it is a diagnosis of exclusion, which would not have the histopathologic findings of the elimination of collagen from the epidermis, as was demonstrated in our patient.11 Elastosis perforans serpiginosa is in the same family of perforating diseases as RPC; however, EPS typically appears in children or young adults and often is associated with other genetic disorders. Physical examination in a patient with EPS would reveal keratotic papules in a serpiginous pattern, whereas our patient had discrete lesions without any serpiginous pattern. The histopathologic appearance of EPS would reveal plugs of elastic fibers rather than collagen fibers, as was demonstrated in our patient.8 Perforating folliculitis, while also demonstrating transepithelial elimination similar to RPC, would appear as erythematous follicular papules with small central keratotic plugs and histopathologic findings of a widely dilated follicle with a mass of keratotic debris.12 Prurigo nodularis would appear as dome-shaped papulonodules with varying degrees of scale, crust, and erosion, with a histopathologic appearance of hyperplasia and thick hyperkeratosis.11
OCT is a noninvasive option to better differentiate difficult-to-diagnose lesions. The OCT revealed well-defined, circumferential, grape-cluster-like, hypo-reflective (darker/shadow) areas, which represent tumor islands similar to what one would see with an H&E biopsy (Figure 3). This eliminated the doubt that it may be an excoriated acne lesion and confirmed the need for biopsy, which confirmed nodular BCC.
OCT of BCC versus excoriated acne. In the above picture of a BCC, the hypo-reflective/shadow, circumferential areas represent tumor islands seen on H&E. The nonspecific, disorganized hypo-reflection seen around hair follicles is clear in this example of acne vulgaris.
Excoriation describes skin damage from mechanical injury. It may also be referred to as a scratch. Depth of excoriated tissue is typically superficial or partial thickness. It may reach into but not through the dermis. Excoriation presents as a well-defined injury with sharp or linear edges, most often located on the extremities. Excoriation may also be a sign of factitial dermatitis. Factitial dermatitis is a term for self-inflicted skin injury which is often identified as linear wounding that occurs in areas within reach such as the abdomen, anterior chest, face or extremities.
In the wake of the war, the twelve dragonmarked houses created codified rules around their co-existence with each other. One result of these new rules was excoriation. Having seen the proliferation of aberrant dragonmarks, the twelve houses banned the mingling of dragonmarked bloodlines. Any marked member of a house found to have mixed blood with another house (whether a marked member or not) was "excoriated", which meant that their dragonmark was to be flayed from their skin and, should they survive, they would be banished from the house forever. On most occasions, excoriation was intentionally lethal, for the dragonmark could grow back with healing.
During the Shadow Schism, the head of House Phiarlan, Elvinor Elorrenthi d'Phiarlan, named the entire Thuranni bloodline excoriated after their treachery. Its members created a new dragonmarked house: House Thuranni. The rivalry between Phiarlan and Thuranni continues to this day, with any member of House Thuranni considered shunned by members of House Phiarlan. The other dragonmarked houses, however, have recognized the legitimacy of House Thuranni and do not shun this house of excoriates.[1][4]
Senate Minority Leader Mitch McConnell excoriated former President Trump Saturday in a speech on the Senate floor shortly after McConnell voted to acquit in the former president's second impeachment trial. In a speech with a first half reminiscent of the arguments made by House impeachment managers, McConnell said the former president was "practically and morally responsible" for the attack on the Capitol on January 6.
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