Acne vulgaris is one of the most common dermatological conditions affecting adolescents, a stage characterized by rapid physical and emotional change. Although often regarded as a self-limited disorder, acne extends well beyond its clinical presentation and exerts a significant psychosocial burden. Studies have shown that visible lesions, particularly on the face, can impair self-image, diminish confidence, and interfere with daily social interactions [1,2]. Even mild or moderate acne may influence peer relationships, academic performance, and routine activities, underscoring its broader impact on adolescent life.

Body-image disturbance is a central concern in this age group. Adolescents place considerable emphasis on appearance, and any deviation from perceived norms may trigger dissatisfaction, heightened self-scrutiny, or avoidance behaviors. Research confirms that individuals with acne frequently report negative body-image perceptions and greater appearance-related distress compared with those without acne [3,4]. Such concerns may progress to emotional difficulties, including low self-esteem, irritability, and persistent negative mood.

Depressive symptoms are another recognized consequence associated with acne. Evidence suggests that the visibility of acne lesions, combined with societal pressures regarding appearance, contributes to emotional vulnerability and depressive features in affected adolescents [4–6]. These challenges may be particularly pronounced when acne is severe, persistent, or socially stigmatizing.

Late adolescence represents a developmental stage in which psychological resilience and fragility coexist. Understanding how acne severity influences body-image disturbance and depressive symptoms in this population is essential for early recognition of at-risk individuals. Against this background, the present study was undertaken to examine the association between acne severity, body-image disturbance, and depressive symptoms among late adolescents. By exploring these relationships, the study aims to emphasize the need for holistic, patient-centered strategies in the dermatologic management of adolescent acne.

Study Design and Setting

This study employed a cross-sectional observational design. It was carried out in the Department of Dermatology at the RVM Institute of Medical Sciences & Research Center, Mulugu, Siddipet, Telangana. The study was conducted over a five-month period, from May 2025 to September 2025. The dermatology outpatient clinic served as the primary recruitment site.

Study Population

Late adolescents aged 16–19 years presenting with clinically diagnosed acne vulgaris were invited to participate. A total of 100 adolescents who met the inclusion criteria and provided informed consent were enrolled.

Inclusion Criteria

• Adolescents aged 16–19 years
• Clinical diagnosis of acne vulgaris
• Willingness to participate and provide informed consent

Exclusion Criteria

Current use of systemic retinoids or antidepressants

Presence of major psychiatric illness diagnosed previously

Facial dermatoses other than acne that could influence appearance scores

Chronic medical conditions affecting mood or self-perception

Assessment of Acne Severity

Acne severity was assessed by a dermatologist using a standardized clinical grading scale. Participants were classified into three categories—mild, moderate, and severe—based on the number, type, and distribution of lesions.

Body Image Disturbance Measurement

Body-image disturbance was evaluated using a validated body-image questionnaire suitable for adolescents. The tool measured appearance-related concerns, self-perception, and emotional reactions. Scores were recorded as continuous variables, with higher values indicating greater disturbance.

Assessment of Depressive Symptoms

Depressive symptoms were measured using a widely accepted adolescent depression inventory. The scale captured mood, interest, sleep, appetite, and cognitive changes. A standard clinical cut-off was used to identify participants with significant depressive symptoms.

Data Collection Procedure

After clinical evaluation, participants completed the questionnaires in a quiet room with the assistance of a trained investigator. Demographic data, including age and gender, were recorded. Each assessment took approximately 15–20 minutes.

Sample Size

A sample size of 100 adolescents was selected based on feasibility and the expected prevalence of psychological impact among individuals with acne.

Statistical Analysis

Descriptive statistics were used to summarize demographic variables and scale scores. Mean differences in body-image disturbance and depressive symptoms across acne categories were evaluated using ANOVA. Pearson correlation analysis was applied to examine associations between acne severity, body-image disturbance, and depressive symptoms. A p-value < 0.05 was considered statistically significant. Statistical analyses were performed using standard statistical software.

Ethical Considerations

The study protocol was reviewed and approved by the Institutional Ethics Committee of RVM Institute of Medical Sciences & Research Center, Mulugu, Siddipet. Participation was voluntary, and confidentiality was maintained throughout the study.

A total of 100 late adolescents were enrolled in the study. The mean age of the participants was 18.7 ± 1.2 years, and females constituted 56% of the sample (Table 1).

Table 1. Demographic Profile of Participants (N = 100)

The distribution of acne severity showed that 34% had mild acne, 41% had moderate acne, and 25% presented with severe acne (Table 2).

Table 2. Distribution of Acne Severity

Body image disturbance scores increased progressively across severity grades. Participants with mild acne reported a mean score of 18.4 ± 4.2, those with moderate acne recorded 24.7 ± 5.1, and adolescents with severe acne demonstrated markedly higher scores (31.6 ± 6.4). The difference across groups was statistically significant (p < 0.001) (Table 3).

Table 3. Body Image Disturbance Scores Across Acne Severity

Figure 1: Body Image Disturbance Scores Across Acne Severity

Depressive symptoms followed a similar gradient. The mean depression score rose from 6.8 ± 3.1 in the mild group to 10.9 ± 4.5 among those with moderate acne, reaching 15.7 ± 5.3 in the severe acne group. Notably, 38% of adolescents with severe acne crossed the clinical cut-off for depressive symptoms, compared with 12% in the moderate category and only 3% among those with mild acne. This trend was significant (p < 0.001) (Table 4).

Table 4. Depressive Symptom Scores and Clinical Cut-off

Correlation analysis demonstrated strong positive associations between acne severity and body-image disturbance (r = 0.61, p < 0.001), as well as between acne severity and depressive symptoms (r = 0.54, p < 0.001). Body-image disturbance and depressive symptoms were also closely correlated (r = 0.58, p < 0.001), indicating a shared emotional burden (Table 5).

Table 5. Correlation Between Key Study Variables

The present study examined how acne severity relates to body-image disturbance and depressive symptoms among late adolescents in a tertiary care setting. A clear pattern emerged in which increasing acne severity was accompanied by greater appearance-related concerns and rising levels of depressive symptoms. This reinforces the understanding that acne is not merely a superficial dermatological problem but a condition with meaningful psychological effects during adolescence.

The gradient of body-image disturbance observed across mild, moderate, and severe acne categories aligns with earlier work documenting that acne frequently triggers dissatisfaction, embarrassment, and negative self-evaluation. Previous research has shown that psychological impairments, including reduced confidence and heightened self-consciousness, are common in individuals with acne, regardless of lesion type or duration [7]. These concerns are especially prominent in adolescents, who often link physical appearance with social acceptance and peer belonging.

Depressive symptoms in the present study followed a similar upward trajectory with increasing acne severity. This finding is consistent with evidence showing that mood changes, emotional distress, and depressive features may appear alongside moderate to severe acne, particularly when lesions interfere with social interactions or self-perception [8]. Long-term cohort data also suggest that acne can have lasting effects, contributing to mental-health difficulties that may persist into adulthood [9]. Such observations emphasize the cumulative emotional burden that acne can impose during critical developmental years.

The significant association between body-image disturbance and depressive symptoms observed here further highlights the psychological interplay within acne-affected adolescents. Studies using validated tools such as CADI, DLQI, and WHOQoL have shown that poorer quality-of-life scores are tightly linked with both acne severity and psychological distress, suggesting that appearance concerns may mediate emotional dysfunction [10]. This relationship has been noted across diverse populations, with more severe acne consistently predicting lower well-being and higher depressive symptomatology [11].

Quality-of-life studies among adolescents and young adults further support these findings, demonstrating that acne severity is a strong predictor of reduced emotional, social, and functional well-being [12]. Anxiety and depressive symptoms have also been shown to occur more frequently in adolescents with visibly inflamed or persistent lesions, indicating that psychological difficulties may be intrinsic to the acne experience itself [13]. Taken together, this evidence underscores the need to view acne not solely as a dermatologic disorder but as a condition requiring integrated psychological assessment.

Despite its strengths, the study has certain limitations. The cross-sectional design limits the ability to determine causal relationships between acne severity and psychological outcomes. The study relied on self-reported psychological scales, which may be influenced by respondent mood or social desirances. Additionally, participants were recruited from a single tertiary center, and the findings may not fully represent adolescents in community settings. Future research involving larger, multi-center cohorts and longitudinal follow-up would help clarify the temporal sequence of these associations.

This study demonstrates that acne severity in late adolescents is closely linked with increasing body-image disturbance and higher levels of depressive symptoms. As the clinical grade of acne worsened, participants reported greater dissatisfaction with their appearance and a marked rise in emotional distress. The strong correlations among acne severity, body-image concerns, and depressive features highlight the complex psychosocial impact of this common dermatological condition. These findings emphasize the need for a holistic approach in adolescent acne care, integrating psychological screening and timely support alongside routine dermatological treatment. Early recognition of emotional difficulties may improve both clinical outcomes and overall well-being in affected adolescents.

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