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.