Psychogenic excoriation affects up to 2% of patients in dermatology clinics and leads to marked functional disability, further emotional distress, and medical complications. Patients often develop disfiguring ulcers and scars as a result of uncontrollable skin picking and gouging. Psychogenic excoriation is not explicitly classified in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), but implicitly falls within the category of "impulse control disorders not otherwise specified". From the dermatological point of view, active acne vulgaris lesions, as well as the associated excoriations, ulcers, and scars, should be treated simultaneously. Self-inflicted skin ulcers and scars are often observed in patients with compulsive skin picking. Psychogenic excoriation poses a diagnostic and treatment challenge because patients often also have an undiagnosed underlying psychiatric disorder. Early and ongoing psychotherapeutic intervention will increase the likelihood of more effective management of this complex psychodermatosis.