Acne vulgaris is one of the most common dermatological disorders affecting adolescents and young adults worldwide, with prevalence estimates reaching up to 85% in this age group. (1) Although often considered a benign cosmetic condition, acne can produce substantial psychosocial distress because visible lesions on the face and body may adversely affect self-perception, interpersonal relationships, and daily social functioning. (2) The condition commonly begins during adolescence, a period marked by heightened sensitivity to appearance, body image, and peer acceptance, thereby increasing vulnerability to psychological disturbances. (3) A growing body of evidence shows that acne is associated with reduced self-esteem, impaired body image, and increased anxiety symptoms. (4,5) Adolescents and young adults with acne have been reported to experience significantly greater psychological distress than unaffected individuals, and self-esteem may decline as perceived disease burden increases. (6,7) Body image disturbance is also common in acne patients and is significantly related to perceived stress and lower self-esteem. (8) Indian hospital-based studies have likewise shown that patients with acne may have lower self-esteem and higher anxiety scores, with more severe acne often associated with greater psychosocial burden. (9) Social anxiety is another important but often under-recognized consequence of acne vulgaris. (10) Patients may experience embarrassment, fear of negative evaluation, and social withdrawal because of visible lesions, even when clinical severity is not uniformly high. (11) Acne severity and acne-related quality of life have also been linked to depressive symptoms and poorer psychosocial health. (8) Population-based evidence further suggests that acne adversely affects quality of life and psychic health, with implications for self-esteem, body image, and relationships with others. (10) Recent research also indicates that even mild-to-moderate acne can negatively affect body image and psychological well-being, highlighting the need for integrated dermatological and mental health care.

A hospital-based cross-sectional study will be conducted among young adults attending the Dermatology Outpatient Department of a tertiary care hospital. Participants aged 18–25 years with clinically diagnosed acne vulgaris will be included. Patients with known psychiatric illness, other disfiguring dermatological disorders, severe systemic illness, or those unwilling to participate will be excluded. Acne severity will be assessed by a dermatologist using the Global Acne Grading System, which is commonly used in acne-related psychosocial studies. Psychosocial outcomes will be measured using standardized instruments: the Rosenberg Self-Esteem Scale for self-esteem, a validated Body Image Scale/questionnaire for body image, and the Liebowitz Social Anxiety Scale for social anxiety. Relevant sociodemographic and clinical variables will be recorded using a predesigned semi-structured proforma. Sample size will be calculated using the formula n=4pq/d2, assuming 50% prevalence of psychosocial impact in the absence of a precise local estimate, 95% confidence level, and 10% relative precision. Thus, n=4×50×50/102=100. After adding 10% for possible non-response, the final sample size will be 110 participants. Consecutive eligible patients attending the outpatient department during the study period will be recruited until the required sample size is achieved. Data will be entered in Microsoft Excel and analyzed using SPSS version 25. Descriptive statistics will be expressed as mean with standard deviation or frequency with percentage. Association between acne severity and psychosocial outcomes will be assessed using Chi-square test and t-test/ANOVA as appropriate. A p-value <0.05 will be considered statistically significant.

A total of 110 young adults with acne vulgaris were included in the study. The majority belonged to the 21–23 years age group 41 (37.3%), followed by 24–25 years 37 (33.6%) and 18–20 years 32 (29.1%). Females constituted 72 (65.5%) of the participants. Most participants were from urban areas (58.2%), were undergraduates (76.4%), unmarried (94.5%), and belonged to nuclear families (66.4%). More than half 58 (52.7%) belonged to the middle socioeconomic class. (Table 1). Table 1: Sociodemographic characteristics of the study participants (n=110) Variable Category n % Age group (years) 18–20 32 29.1 21–23 41 37.3 24–25 37 33.6 Sex Male 38 34.5 Female 72 65.5 Residence Rural 46 41.8 Urban 64 58.2 Educational status Undergraduate 84 76.4 Postgraduate 26 23.6 Marital status Unmarried 104 94.5 Married 6 5.5 Family type Nuclear 73 66.4 Joint 37 33.6 Socioeconomic status Lower middle 19 17.3 Middle 58 52.7 Upper middle 33 30.0 The clinical characteristics of acne vulgaris are presented in Table 2. More than half of the participants 58 (52.7%) had acne for more than 12 months. The face alone was the most commonly affected site 67 (60.9%), followed by involvement of both the face and body 29 (26.4%). Papulopustular acne was the predominant lesion type 58 (52.7%), followed by nodulocystic (27.3%) and comedonal acne (20.0%), indicating that inflammatory lesions were the most frequent clinical presentation. (Table 2) Table 2: Clinical characteristics of acne vulgaris among study participants (n=110) Variable Category n % Duration of acne < 6 months 18 16.4 6–12 months 34 30.9 > 12 months 58 52.7 Site of lesions Face only 67 60.9 Face and body 29 26.4 Body only 14 12.7 Type of lesions Comedonal 22 20.0 Papulopustular 58 52.7 Nodulocystic 30 27.3 As shown in Table 3, moderate acne according to the Global Acne Grading System (GAGS) was the most common severity category 46 (41.8%), followed by severe (25.5%), mild (23.6%), and very severe acne (9.1%). Subjectively, an equal proportion of participants perceived their acne as moderate (43.6%) and severe (43.6%), whereas only 12.7% considered it mild. Previous treatment for acne vulgaris had been received by 79 (71.8%) participants. (Table 3). Table 3: Acne severity and treatment profile among study participants (n = 110) Variable Category n % Acne severity by Global Acne Grading System (GAGS) Mild 26 23.6 Moderate 46 41.8 Severe 28 25.5 Very severe 10 9.1 Subjective severity perception Mild 14 12.7 Moderate 48 43.6 Severe 48 43.6 Previous treatment history Yes 79 71.8 No 31 28.2 Low self-esteem was observed in 48 (43.6%) participants, while 62 (56.4%) had normal self-esteem. Disturbed body image was reported by 51 (46.4%) participants, whereas 59 (53.6%) reported a normal body image. Social anxiety was present in 44 (40.0%) participants and absent in 66 (60.0%). Overall, nearly half of the participants experienced impaired self-esteem and body image, while two-fifths reported social anxiety, indicating a considerable psychosocial burden associated with acne vulgaris. (Figure 1). Table 4: Association between acne severity and psychosocial outcomes among study participants (n=110) Acne severity by GAGS Low self-esteem n (%) Normal self-esteem n (%) P* value Disturbed body image n (%) Normal body image n (%) P* value Social anxiety present n (%) Social anxiety absent n (%) P* value Mild (n=26) 6 (23.1) 20 (76.9) 0.008 7 (26.9) 19 (73.1) 0.04 5 (19.2) 21 (80.8) 0.015 Moderate (n=46) 18 (39.1) 28 (60.9) 21 (45.7) 25 (54.3) 16 (34.8) 30 (65.2) Severe (n=28) 16 (57.1) 12 (42.9) 15 (53.6) 13 (46.4) 15 (53.6) 13 (46.4) Very severe (n=10) 8 (80.0) 2 (20.0) 8 (80.0) 2 (20.0) 8 (80.0) 2 (20.0) Total 48 (43.6) 62 (56.4) 51 (46.4) 59 (53.6) 44 (40.0) 66 (60.0) *represents application of Chi square test. Table 4 shows that low self-esteem increased with acne severity, from 6 (23.1%) in mild acne to 8 (80.0%) in very severe acne, while normal self-esteem decreased accordingly. Disturbed body image was seen in 7 (26.9%) of mild cases, 21 (45.7%) of moderate cases, 15 (53.6%) of severe cases, and 8 (80.0%) of very severe cases. Social anxiety also showed a similar trend, with 5 (19.2%) in mild acne, 16 (34.8%) in moderate acne, 15 (53.6%) in severe acne, and 8 (80.0%) in very severe acne. The association between acne severity and low self-esteem, disturbed body image, and social anxiety was statistically significant (p<0.05). (Table 4). Table 5: Comparison of mean psychosocial scores across acne severity groups among study participants (n=110) Acne severity by GAGS Self-esteem score mean ± SD Body image score mean ± SD Social anxiety score mean ± SD Mild (n=26) 28.6 ± 3.2 22.1 ± 2.8 18.4 ± 3.1 Moderate (n=46) 24.7 ± 3.5 26.8 ± 3.4 23.9 ± 3.8 Severe (n=28) 20.5 ± 4.1 30.9 ± 4.0 29.7 ± 4.5 Very severe (n=10) 16.8 ± 3.7 35.2 ± 4.3 34.6 ± 4.1 ANOVA p value P=0.03 <0.015 <0.024 Table 5 demonstrated that the mean self-esteem score decreased progressively with increasing acne severity, from 28.6 ± 3.2 in mild acne to 16.8 ± 3.7 in very severe acne. In contrast, the mean body image score increased from 22.1 ± 2.8 in mild acne to 35.2 ± 4.3 in very severe acne, indicating worsening body image disturbance with greater severity. A similar pattern was observed for social anxiety, with scores rising from 18.4 ± 3.1 in mild acne to 34.6 ± 4.1 in very severe acne. The differences in mean self-esteem, body image, and social anxiety scores across acne severity groups were statistically significant, with p values of less than 0.05 for all three variables. (Table 5).

The present study included 110 young adults with acne vulgaris, with the highest proportion belonging to the 21–23 years age group (37.3%), followed by 24–25 years (33.6%) and 18–20 years (29.1%). Females constituted nearly two-thirds (65.5%) of the study population. More than half of the participants were urban residents (58.2%), undergraduate students (76.4%), unmarried (94.5%), and belonged to nuclear families (66.4%). The predominance of young adults observed in the present study is expected, as acne vulgaris commonly manifests during adolescence and early adulthood when hormonal changes and heightened concern regarding physical appearance are most prominent. Similar findings were reported by Hazarika and Archana, who observed that acne predominantly affected adolescents and young adults, with females constituting a larger proportion of patients seeking treatment. (1) Morshed et al. also reported a predominance of young adults and female participants in their study evaluating the psychological consequences of acne vulgaris. (3) Tasoula et al. found that acne was highly prevalent among adolescents and young adults and significantly affected psychosocial functioning during this critical developmental period. (10) Likewise, Kazan et al. reported a higher proportion of female acne patients and highlighted the greater psychological burden experienced by women due to societal emphasis on facial appearance and attractiveness. (4) The predominance of urban participants in the present study may reflect greater awareness regarding dermatological care and easier access to tertiary healthcare facilities. The present study revealed that more than half of the participants (52.7%) had acne duration exceeding one year, indicating the chronic nature of the disease. Facial involvement alone was observed in 60.9% of participants, while 26.4% had lesions affecting both face and body. Moderate acne severity was the most common presentation (41.8%), followed by severe acne (25.5%). Papulopustular acne constituted the predominant lesion type (52.7%), and 71.8% of participants reported previous treatment history. Furthermore, 43.6% perceived their acne as severe, suggesting that subjective disease perception may exceed objectively measured severity. These findings are consistent with those reported by Hazarika and Archana, who found that facial lesions and moderate acne severity were common among dermatology attendees. (1) Tan emphasized that facial acne carries a greater psychosocial burden because of its visibility and impact on social interactions. (2) Yoqub et al. reported that persistent acne and facial involvement were strongly associated with lower self-esteem and poorer quality of life among adolescents. (6) Morshed et al. similarly observed that prolonged disease duration was associated with increased psychological distress and impaired quality of life. (3) Pratheepa and Gupta found that increasing acne severity was associated with greater body image disturbance and emotional difficulties among adolescents and young adults. (7) These observations suggest that both clinical severity and patients’ subjective perception of acne contribute substantially to psychosocial outcomes. The present study demonstrated that 43.6% of participants had low self-esteem, 46.4% experienced disturbed body image, and 40.0% reported social anxiety. These findings indicate that acne vulgaris imposes a considerable psychosocial burden on affected young adults. The visibility of lesions, particularly on the face, may negatively influence self-confidence, interpersonal relationships, and participation in social activities. Comparable findings were reported by Yoqub et al., who observed significantly reduced self-esteem and impaired body image among adolescents with acne vulgaris. (6) Aman et al. reported that acne patients frequently experienced low self-esteem and anxiety symptoms, with psychosocial impairment increasing alongside disease burden. (5) Kazan et al. also demonstrated significantly lower self-esteem and higher anxiety levels among acne patients compared with controls. (4) Furthermore, Unal et al. reported higher social anxiety scores and lower self-esteem among adolescents with acne vulgaris than among healthy individuals. (12) Similar observations were reported by Yolaç Yarpuz et al., who identified social anxiety as a common psychological consequence of acne vulgaris. (8) The present study demonstrated a statistically significant association between acne severity and psychosocial outcomes. The prevalence of low self-esteem increased from 23.1% among participants with mild acne to 80.0% among those with very severe acne (p=0.008). Similarly, disturbed body image increased from 26.9% in mild acne to 80.0% in very severe acne (p=0.04). Social anxiety also showed a progressive increase, rising from 19.2% among participants with mild acne to 80.0% among those with very severe acne (p=0.015). These findings indicate that worsening acne severity is associated with progressively greater psychosocial impairment. Similar findings were reported by Morshed et al., who demonstrated that increasing acne severity was significantly associated with lower self-esteem, greater psychological distress, and poorer quality of life. (3) Pratheepa and Gupta observed a strong positive relationship between acne severity and body image disturbance among late adolescents. (7) Uslu et al. also found that severe acne was associated with significantly poorer body image perception and adverse mental health outcomes. (11) Xu et al. reported that patients with severe acne experienced greater social avoidance, embarrassment, and fear of negative evaluation compared with those having mild disease. (9) Likewise, Unal et al. found significantly higher social anxiety levels among participants with moderate and severe acne than among those with mild acne. (12) The findings of the present study are further supported by Özkesici Kurt, who reported significantly lower self-esteem and body satisfaction among patients with more severe acne lesions. (13) Marron et al. observed that emotional distress and quality-of-life impairment increased progressively with acne severity. (14) Similarly, Layton et al., in a recent systematic review, concluded that increasing acne severity is consistently associated with poorer psychosocial well-being, reduced self-esteem, and greater emotional distress. (15) These findings collectively support the strong association between acne severity and psychosocial morbidity observed in the present study. The present study demonstrated a significant decline in mean self-esteem scores with increasing acne severity, decreasing from 28.6±3.2 in mild acne to 16.8±3.7 in very severe acne (p=0.03). Conversely, mean body image scores increased from 22.1±2.8 among participants with mild acne to 35.2±4.3 among those with very severe acne (p<0.015). Mean social anxiety scores also increased progressively from 18.4±3.1 to 34.6±4.1 (p<0.024). These findings suggest a clear dose-response relationship between acne severity and psychosocial impairment. Comparable findings were reported by Kazan et al., who demonstrated significantly lower self-esteem and higher anxiety scores among patients with severe acne. (4) Özkesici Kurt observed that worsening acne severity was associated with lower self-esteem, poorer body satisfaction, and reduced quality of life. (13) Morshed et al. similarly reported that increasing acne severity independently predicted poorer psychosocial outcomes and quality-of-life scores. (3) Do et al. found that adolescents with acne experienced significant impairment in self-image, interpersonal relationships, and emotional well-being compared with unaffected peers. (16) Furthermore, Layton et al. concluded that self-esteem, body image, social functioning, and overall psychological well-being deteriorate progressively as acne severity increases. (15) These findings reinforce the importance of incorporating psychosocial assessment and counselling into routine acne management, particularly among patients with moderate-to-severe disease.

The present study demonstrates that acne vulgaris has a substantial psychosocial impact on young adults, affecting self-esteem, body image, and social anxiety. Nearly half of the participants experienced low self-esteem, disturbed body image, and social anxiety, highlighting the significant emotional burden associated with the condition. Furthermore, worsening acne severity was significantly associated with greater psychosocial impairment, as evidenced by declining self-esteem scores and increasing body image disturbance and social anxiety levels. These findings emphasize that acne vulgaris should not be regarded solely as a cosmetic disorder but as a condition with important psychological and social consequences. Routine assessment of psychosocial well-being, along with appropriate counselling and timely dermatological management, may help improve overall patient outcomes and quality of life among affected young adults

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