CO2 Laser Plus CBT Shows Benefit in Postadolescent Acne Excoriée Case Series

A combined psychodermatologic approach integrating CO₂ laser ablation and cognitive-behavioral therapy (CBT) was associated with clinical improvement in patients with treatment-resistant postadolescent acne excoriée, according to a case series published in the February 2026 issue of Journal of Cosmetic Dermatology.

Investigators evaluated three patients with chronic, refractory postadolescent acne excoriée, a condition characterized by compulsive skin picking that perpetuates inflammatory acne lesions. The authors noted that self-inflicted trauma may contribute to lesion persistence, sebaceous gland epithelialization, and cystic transformation, complicating conventional acne management.

Patients underwent CO₂ laser ablation targeting obstructed sebaceous glands, alongside CBT aimed at modifying maladaptive excoriation behaviors. The combined intervention was designed to address both the cutaneous pathology and the underlying psychological drivers contributing to disease chronicity.

All three patients experienced rapid and sustained improvement, according to the authors. Clinical benefits included elimination of visibly obstructed sebaceous glands and reduction in compulsive skin manipulation behaviors. The authors reported that the integrated strategy disrupted the “pathomimetic cycle” contributing to lesion persistence.

In the abstract conclusion, the authors wrote, “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.”