Individuals with visible facial acne experience worse psychopathological symptoms after treatment than those with non-visible conditions, according to a recent study, reinforcing calls for integrated psychological support within dermatology care.
While dermatological disorders are known to affect emotional wellbeing, the relationship between visible skin disease and psychopathology is not completely understood.
Previous studies examining acne, psoriasis and eczema have reported conflicting findings, particularly regarding whether psychological distress improves following dermatological treatment.
Published in the Journal of Health Psychology, a prospective, six-month longitudinal study compared levels of psychopathology in patients with visible facial acne and those with non-visible psoriasis or eczema, before and after dermatological treatment, relative to healthy controls.
Participants included 162 adults aged 18–35 years, divided equally into three groups: patients with severe facial cystic acne, patients with psoriasis or eczema without visible localisation, and individuals without skin conditions as controls.
Patients with acne were treated with oral retinoids and antibiotics, while those with psoriasis or eczema received oral corticosteroids, antibiotics and topical therapies.
Psychopathology was assessed before and after treatment using the Symptom Checklist-90-Revised (SCL-90-R), which evaluates dimensions such as anxiety, depression, obsessive-compulsive disorder (OCD), somatisation and paranoid ideation.
The SCL-90-R was readministered to all participants six months after their initial assessments.
Visible acne and psychopathological symptoms
Both dermatological patient groups exhibited significantly higher psychopathology scores than the controls before and after treatment. However, patients with visible facial acne demonstrated a distinct worsening of several symptoms following treatment completion.
Somatisation scores in the acne group rose from 0.86 before treatment to 1.40 after treatment, while OCD symptom scores increased from 1.75 to 1.91.
Anxiety scores also rose significantly, from 1.13 to 1.27, as did paranoid ideation scores, which increased from 1.24 to 1.49.
Overall psychological distress, measured by the Global Severity Index, rose from 105.59 to 124.62 after treatment in the acne group.
By contrast, no comparable deterioration was observed in the psoriasis/eczema or control groups.
The authors noted that visibility of facial acne may act as a ‘psychosocial amplifier of distress’, increasing self-consciousness, perceived social scrutiny and emotional vulnerability.
The findings suggest that clinical improvement in skin symptoms does not necessarily translate into psychological relief and may, in some cases, coincide with heightened psychological vulnerability.
The authors noted that this worsening among acne patients could be connected to isotretinoin treatment, which has been linked to emotional instability in vulnerable individuals.
However, they also emphasised that existing evidence does not support a general causal relationship between isotretinoin and psychopathology.
Integrated psychosocial support
The importance of close collaboration between dermatologists and mental health professionals, including routine psychological screening and supportive interventions for patients with acne, particularly those undergoing isotretinoin therapy, was highlighted by the authors.
This included recommendations for routine psychological screening and access to supportive interventions for patients with acne who may be vulnerable to worsening distress after treatment.
Several study limitations were acknowledged, including the relatively small sample size of 162 adults, reliance on self-reported measures and the absence of clinical psychiatric interviews to confirm diagnoses.
However, strengths included the prospective design, inclusion of both visible and non-visible skin disorders and the use of a control group without skin conditions.
The authors advocated for integrated dermatological and psychological care models to address both the physical and emotional burden of visible skin conditions. And they concluded that future research should include larger cohorts, multiple follow-up assessments and the incorporation of biological markers of inflammation and immune activity to explore links between dermatological disease and psychopathology.
Reference
Costeris C, Petridou M. Psychopathology in acne, psoriasis, and eczema patients: Pre- and post-treatment. J Health Psychol 2026;Apr 15:13591053261438310.
This article was originally published by our sister publication Hospital Healthcare Europe.
