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 excori- ated acne may be quickly classified as psychosomatic or even psychiatric cases, and dermatologists may be overlooking opportu- nities to help. This report presents the case of a young woman with excoriated acne and anorexia nervosa, treated with a combina- tion 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.