Psychological Factors to Consider in Treating Patients with Acne Vulgaris

Acne vulgaris is a chronic inflammatory skin disease associated with a substantial psychological burden that may extend beyond visible lesions and objective disease severity. Psychological factors such as stress, coping strategies, quality-of-life impairment, self-esteem, psychiatric symptoms, and treatment adherence are associated with disease perception, self-reported exacerbation, and treatment-related outcomes. This narrative review examines psychological stress and proposed biological mechanisms, coping strategies, treatment adherence, quality of life, self-esteem, sleep disturbance, and psychiatric comorbidity in people with acne. Relevant literature was identified through MEDLINE/PubMed, Scopus, Web of Science, and PsycINFO; the final literature search was conducted on 29 May 2026. Acne-specific studies were prioritized, with broader psychodermatology evidence used where acne-specific data were limited. The psychosocial burden of acne is individualized and only partly aligned with clinician-rated severity, supporting person-centered assessment. For each domain, the review outlines brief, commonly used screening instruments that may be feasible in routine dermatology. Incorporating psychological assessment and targeted supportive strategies into acne care may contribute to quality of life, adherence to therapy, and patient-centered care. The evidence is predominantly cross-sectional and derives from heterogeneous populations, instruments, and study designs, limiting causal inference.