{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:24:38Z","timestamp":1786973078075,"version":"build-2736575974"},"reference-count":153,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm15166347","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T12:01:26Z","timestamp":1786968086000},"page":"6347","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychological Factors to Consider in Treating Patients with Acne Vulgaris"],"prefix":"10.3390","volume":"15","author":[{"given":"Julia","family":"Wo\u017ana","sequence":"first","affiliation":[{"name":"Department of Dermatology and Venereology, Poznan University of Medical Sciences, 60-355 Pozna\u0144, Poland"},{"name":"Doctoral School, Poznan University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"Pazdrowski","sequence":"additional","affiliation":[{"name":"Doctoral School, Poznan University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Welc","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Poznan University of Medical Sciences, 60-355 Pozna\u0144, Poland"},{"name":"Doctoral School, Poznan University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anita","family":"P\u0142\u00f3cienniczak","sequence":"additional","affiliation":[{"name":"Faculty of Medicine for Ms Anita P\u0142\u00f3cienniczak, Pozna\u0144 University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9473-1239","authenticated-orcid":false,"given":"Katarzyna","family":"Korecka","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Poznan University of Medical Sciences, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryszard","family":"\u017baba","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Poznan University of Medical Sciences, 60-355 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3724-2391","authenticated-orcid":false,"given":"Andrzej","family":"Grzybowski","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, University of Warmia and Mazury, 10-719 Olsztyn, Poland"},{"name":"Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61-553 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewa","family":"Mojs","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, Poznan University of Medical Sciences, 61-701 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1111\/bjd.19477","article-title":"Reviewing the global burden of acne: How could we improve care to reduce the burden?","volume":"184","author":"Layton","year":"2020","journal-title":"Br. J. Dermatol."},{"key":"ref_2","first-page":"1185","article-title":"Female type of adult acne: Physiological and psychological considerations and management","volume":"16","author":"Dreno","year":"2018","journal-title":"JDDG J. Dtsch. Dermatol. Ges."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3892\/etm.2021.11074","article-title":"Adult female acne: Clinical and therapeutic particularities (Review)","volume":"23","author":"Branisteanu","year":"2021","journal-title":"Exp. Ther. Med."},{"key":"ref_4","first-page":"1080","article-title":"Psychodermatology of acne: Psychological aspects and effects of acne vulgaris","volume":"20","author":"Jafferany","year":"2020","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1093\/bjd\/ljae352","article-title":"Global, regional and national burdens of acne vulgaris in adolescents and young adults aged 10\u201324 years from 1990 to 2021: A trend analysis","volume":"192","author":"Zhu","year":"2024","journal-title":"Br. J. Dermatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s40257-025-00983-3","article-title":"The Burden of Acne Vulgaris on Health-Related Quality of Life and Psychosocial Well-Being Domains: A Systematic Review","volume":"27","author":"Layton","year":"2025","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s40257-020-00564-6","article-title":"Identifying the Impacts of Acne and the Use of Questionnaires to Detect These Impacts: A Systematic Literature Review","volume":"22","author":"Smith","year":"2020","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_8","first-page":"e33357","article-title":"Evaluation of Psychiatric Comorbidities and Quality of Life as Well as Brain-Derived Neurotrophic Factor (BDNF) Concentrations among Patients Suffering from Acne Vulgaris: A Systematic Review and Meta-Analysis","volume":"15","author":"Almutawa","year":"2023","journal-title":"Cureus"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.jaad.2020.02.040","article-title":"Acne vulgaris and risk of depression and anxiety: A meta-analytic review","volume":"83","author":"Samuels","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"731","DOI":"10.2147\/CCID.S406235","article-title":"Beyond the Surface: A Deeper Look at the Psychosocial Impacts of Acne Scarring","volume":"16","author":"Zhou","year":"2023","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1007\/s10935-024-00784-0","article-title":"Global Prevalence of Anxiety, Depression, and Stress Among Patients with Skin Diseases: A Systematic Review and Meta-analysis","volume":"45","author":"Salari","year":"2024","journal-title":"J. Prev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/archderm.139.7.897","article-title":"The Response of Skin Disease to Stress","volume":"139","author":"Chiu","year":"2003","journal-title":"Arch. Dermatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.jdin.2024.09.019","article-title":"The impact of academic stress on acne: An observational cohort study among medical students in Morocco","volume":"18","author":"Bouraqqadi","year":"2024","journal-title":"JAAD Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2340\/00015555-0231","article-title":"Study of Psychological Stress, Sebum Production and Acne Vulgaris in Adolescents","volume":"87","author":"Yosipovitch","year":"2007","journal-title":"Acta Derm.-Venereol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"131","DOI":"10.4103\/jfcm.jfcm_396_22","article-title":"Severity of acne, stress, and food habits of medical students at Taif University, Saudi Arabia","volume":"30","author":"Basfar","year":"2023","journal-title":"J. Fam. Community Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"125","DOI":"10.5021\/ad.2009.21.2.125","article-title":"Psychosocial Aspects of Acne Vulgaris: A Community-based Study with Korean Adolescents","volume":"21","author":"Do","year":"2009","journal-title":"Ann. Dermatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"679","DOI":"10.5114\/ada.2023.132230","article-title":"Is acne vulgaris exacerbated during the military conflict in Ukraine? A self-reported cross-sectional prospective study","volume":"40","author":"Szepietowski","year":"2023","journal-title":"Adv. Dermatol. Allergol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1111\/j.1365-2133.2005.06794.x","article-title":"Does facial sebum excretion really affect the development of acne?","volume":"153","author":"Youn","year":"2005","journal-title":"Br. J. Dermatol."},{"key":"ref_19","first-page":"e14150","article-title":"Psychodermatology of acne: Dermatologist\u2019s guide to inner side of acne and management approach","volume":"33","author":"Kayiran","year":"2020","journal-title":"Dermatol. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1111\/j.1468-3083.2010.03590.x","article-title":"The epidemiology of adolescent acne in North East China","volume":"24","author":"Wei","year":"2010","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e12340","DOI":"10.1111\/appy.12340","article-title":"Stressful life events and psychiatric comorbidity in acne\u2013a case control study","volume":"11","author":"Bondade","year":"2018","journal-title":"Asia-Pac. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Davern, J., and O\u2019Donnell, A.T. (2018). Stigma predicts health-related quality of life impairment, psychological distress, and somatic symptoms in acne sufferers. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0205009"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"E623","DOI":"10.1111\/jdv.18016","article-title":"Perceived stress in four inflammatory skin diseases: An analysis of data taken from 7273 adult subjects with acne, atopic dermatitis, psoriasis or hidradenitis suppurativa","volume":"36","author":"Misery","year":"2022","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_24","first-page":"1133","article-title":"The Impact of Pyschological Stress on Acne","volume":"25","year":"2017","journal-title":"Acta Dermatovenerol. Croat."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.bbi.2023.12.005","article-title":"Role of stress in skin diseases: A neuroendocrine-immune interaction view","volume":"116","author":"Zhang","year":"2023","journal-title":"Brain Behav. Immun."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.clinthera.2020.03.008","article-title":"Stress-induced Interaction of Skin Immune Cells, Hormones, and Neurotransmitters","volume":"42","author":"Pondeljak","year":"2020","journal-title":"Clin. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"ski2.201","DOI":"10.1002\/ski2.201","article-title":"Proopiomelanocortin (POMC) and Psychodermatology","volume":"3","author":"Millington","year":"2023","journal-title":"Ski. Health Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1080\/10253890701754068","article-title":"A link between stress and depression: Shifts in the balance between the kynurenine and serotonin pathways of tryptophan metabolism and the etiology and pathophysiology of depression","volume":"11","author":"Miura","year":"2008","journal-title":"Stress"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1038\/s41574-019-0228-0","article-title":"The human stress response","volume":"15","author":"Russell","year":"2019","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Hole\u010dek, M. (2026). Serotonin, Kynurenine, and Indole Pathways of Tryptophan Metabolism in Humans in Health and Disease. Nutrients, 18.","DOI":"10.3390\/nu18030507"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"681","DOI":"10.2147\/IJGM.S294509","article-title":"Correlation Between Stress Scale and Serum Substance P Level in Acne Vulgaris","volume":"14","author":"Jusuf","year":"2021","journal-title":"Int. J. Gen. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"464","DOI":"10.5021\/ad.2016.28.4.464","article-title":"Stressful Events and Serum Concentration of Substance P in Acne Patients","volume":"28","author":"Pawlaczyk","year":"2016","journal-title":"Ann. Dermatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1998","DOI":"10.1111\/jocd.12940","article-title":"Serum levels of brain-derived neurotrophic factor in patients with acne vulgaris","volume":"18","author":"Mikhael","year":"2019","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_34","first-page":"E69","article-title":"Serum Neurotensin: An Objective Mirror to Acne-induced Quality of Life and Psychological Impairment","volume":"14","author":"Mikhael","year":"2021","journal-title":"J. Clin. Aesthet. Dermatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1021\/acschemneuro.5c00993","article-title":"A Trim21-GSDMD Axis Links Psychosocial Stress to IL-1\u03b2-Driven Neuroinflammation and Blood-Brain Barrier Dysfunction in a Rat Model of Repeated Social Defeat","volume":"17","author":"Tiwari","year":"2026","journal-title":"ACS Chem. Neurosci."},{"key":"ref_36","first-page":"95","article-title":"Effectiveness of oral glutathione in reducing nitric oxide and IL-1\u03b1 concentrations for clinical improvement in mild to moderate acne vulgaris: A randomized controlled trial","volume":"34","author":"Mawu","year":"2025","journal-title":"Acta Dermatovenerol. Alp. Pannonica Adriat."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1792","DOI":"10.1111\/jdv.12431","article-title":"Modulation of sebum oxidation and interleukin-1\u03b1 levels associates with clinical improvement of mild comedonal acne","volume":"28","author":"Capitanio","year":"2014","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3843","DOI":"10.2147\/IJGM.S421835","article-title":"Genetic Variants Associated with Acne Vulgaris","volume":"16","author":"Zhang","year":"2023","journal-title":"Int. J. Gen. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1007\/s11154-016-9367-y","article-title":"Stress-related skin disorders","volume":"17","author":"Alexopoulos","year":"2016","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1177\/12034754231204295","article-title":"The Mind Body Connection in Dermatologic Conditions: A Literature Review","volume":"27","author":"Mar","year":"2023","journal-title":"J. Cutan. Med. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Chen, Y., Peng, L., Li, Y., Peng, Y., Dai, S., Han, K., and Xin, J. (2025). Amplicon-based analysis reveals link between adolescent acne and altered facial skin microbiome induced by negative emotional states. Front. Cell. Infect. Microbiol., 15.","DOI":"10.3389\/fcimb.2025.1543616"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Borrel, V., Thomas, P., Catovic, C., Racine, P.-J., Konto-Ghiorghi, Y., Lefeuvre, L., Duclairoir-Poc, C., Zouboulis, C.C., and Feuilloley, M.G.J. (2019). Acne and Stress: Impact of Catecholamines on Cutibacterium acnes. Front. Med., 6.","DOI":"10.3389\/fmed.2019.00155"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Borrego-Ruiz, A., and Borrego, J.J. (2024). Microbial Dysbiosis in the Skin Microbiome and Its Psychological Consequences. Microorganisms, 12.","DOI":"10.3390\/microorganisms12091908"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1963","DOI":"10.1111\/jdv.17432","article-title":"Adult skin acute stress responses to short-term environmental and internal aggression from exposome factors","volume":"35","author":"Passeron","year":"2021","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_45","first-page":"e73","article-title":"Stigma, Social Appearance Anxiety and Coping in Men and Women Living with Skin Conditions: A Mixed Methods Analysis","volume":"2","author":"Hughes","year":"2021","journal-title":"Ski. Health Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2617","DOI":"10.2147\/CCID.S549119","article-title":"Exploring Social Avoidance and Psychosocial Factors in Young Adults with Acne in East China","volume":"18","author":"Xu","year":"2025","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_47","first-page":"154","article-title":"The contribution of stress in pathogenesis of acne","volume":"100","author":"Cybulski","year":"2013","journal-title":"Dermatol. Rev.\/Przegl. Dermatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1111\/jdv.70245","article-title":"Addiction and chronic skin diseases: A Pan-European study on prevalence, associations and patient impact","volume":"40","author":"Ziehfreund","year":"2025","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Attia, M., Ibrahim, F.A., Elsady, M.A.-E., Khorkhash, M.K., Rizk, M.A., Shah, J., and Amer, S.A. (2022). Cognitive, emotional, physical, and behavioral stress-related symptoms and coping strategies among university students during the third wave of COVID-19 pandemic. Front. Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.933981"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e068","DOI":"10.1097\/JW9.0000000000000068","article-title":"Cognitive behavior therapy as dermatological treatment: A narrative review","volume":"8","author":"Revankar","year":"2022","journal-title":"Int. J. Women\u2019s Dermatol."},{"key":"ref_51","first-page":"e48657","article-title":"Association of Psychological Stress with Skin Symptoms Among the Population in Saudi Arabia: A Cross-Sectional Study","volume":"15","author":"Altalhi","year":"2023","journal-title":"Cureus"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"42","DOI":"10.7748\/ns2014.01.28.22.42.e8166","article-title":"Preventing psychological distress in patients with acne","volume":"28","author":"Mooney","year":"2014","journal-title":"Nurs. Stand."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1111\/ijd.14227","article-title":"A novel cognitive stress management technique for acne vulgaris: A short report of a pilot experimental study","volume":"58","author":"Chatzikonstantinou","year":"2018","journal-title":"Int. J. Dermatol."},{"key":"ref_54","first-page":"e3285","article-title":"A systematic review and meta-analytic confirmatory factor analysis of the perceived stress scale (PSS-10 and PSS-14)","volume":"40","year":"2023","journal-title":"Stress Health"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/0005-7967(94)00075-U","article-title":"The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories","volume":"33","author":"Lovibond","year":"1995","journal-title":"Behav. Res. Ther."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1002\/jclp.10080","article-title":"Use of the Coping Inventory for Stressful Situations in a clinically depressed sample: Factor structure, personality correlates, and prediction of distress","volume":"59","author":"McWilliams","year":"2003","journal-title":"J. Clin. Psychol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1207\/s15327558ijbm0401_6","article-title":"You want to measure coping but your protocol\u2019s too long: Consider the Brief COPE","volume":"4","author":"Carver","year":"1997","journal-title":"Int. J. Behav. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2253","DOI":"10.1111\/jdv.15913","article-title":"A systematic review of factors influencing treatment adherence in chronic inflammatory skin disease\u2014Strategies for optimizing treatment outcome","volume":"33","author":"Eicher","year":"2019","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"25","DOI":"10.2340\/00015555-2452","article-title":"Patient\u2013Doctor Relationship in Dermatology: From Compliance to Concordance","volume":"96","author":"Taube","year":"2016","journal-title":"Acta Derm.-Venereol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1111\/j.1365-4362.1988.tb02416.x","article-title":"Compliance: The Dermatologic Patient","volume":"27","author":"Witkowski","year":"1988","journal-title":"Int. J. Dermatol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"635","DOI":"10.2337\/diacare.22.4.635","article-title":"Beyond \u201ccompliance\u201d is \u201cadherence\u201d. Improving the prospect of diabetes care","volume":"22","author":"Lutfey","year":"1999","journal-title":"Diabetes Care"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"de Lucas, R., Moreno-Arias, G., Perez-L\u00f3pez, M., Vera-Casa\u00f1o, \u00c1., Aladren, S., Milani, M., and on behalf of ACTUO Investigators study group (2015). Adherence to drug treatments and adjuvant barrier repair therapies are key factors for clinical improvement in mild to moderate acne: The ACTUO observational prospective multicenter cohort trial in 643 patients. BMC Dermatol., 15.","DOI":"10.1186\/s12895-015-0036-8"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e14408","DOI":"10.1111\/dth.14408","article-title":"Medication adherence and its possible associated factors in patients with acne vulgaris: A cross-sectional study of 200 patients in Iran","volume":"33","author":"Salamzadeh","year":"2020","journal-title":"Dermatol. Ther."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.jaad.2018.02.032","article-title":"Isotretinoin therapy: A retrospective cohort analysis of completion rates and factors associated with nonadherence","volume":"79","author":"Kazemi","year":"2018","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1111\/j.1365-2133.2009.09253.x","article-title":"Adherence to topical dermatological therapy: Lessons from oral drug treatment","volume":"161","author":"Gupta","year":"2009","journal-title":"Br. J. Dermatol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1001\/archderm.140.4.408","article-title":"Objective Assessment of Compliance with Psoriasis Treatment","volume":"140","author":"Zaghloul","year":"2004","journal-title":"Arch. Dermatol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/pde.12713","article-title":"Medication Adherence in Children and Adolescents with Acne Vulgaris in Medicaid: A Retrospective Study Analysis","volume":"33","author":"Hester","year":"2015","journal-title":"Pediatr. Dermatol."},{"key":"ref_68","first-page":"581","article-title":"Patients with psoriasis and their compliance with medication","volume":"41","author":"Richards","year":"1999","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Brzezi\u0144ski, P., Feszak, I.J., \u015amigielski, J., Kawczak, P., and B\u0105czek, T. (2025). Compliance with the European Pregnancy Prevention Programme in Isotretinoin Treatment: Safety Outcomes and Dose-Related Correlations. J. Clin. Med., 14.","DOI":"10.3390\/jcm14103497"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1016\/S0025-7125(16)30616-2","article-title":"Medication Compliance in the Elderly","volume":"73","author":"Stewart","year":"1989","journal-title":"Med. Clin. N. Am."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1001\/jamadermatol.2014.5254","article-title":"Frequency of Primary Nonadherence to Acne Treatment","volume":"151","author":"Anderson","year":"2015","journal-title":"JAMA Dermatol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"4854","DOI":"10.5826\/dpc.1501a4854","article-title":"Attention Deficit Hyperactivity Disorder and Treatment Adherence in Adolescent Acne Patients: Investigating the Relationship for Better Care Strategies","volume":"15","year":"2025","journal-title":"Dermatol. Pract. Concept."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.24953\/turkjped.2020.06.013","article-title":"Emotion regulation in adolescents with acne vulgaris: Correlates of medication adherence, clinical dimensions and psychopathology symptoms: A cross-sectional study","volume":"62","author":"Turan","year":"2020","journal-title":"Turk. J. Pediatr."},{"key":"ref_74","first-page":"324","article-title":"Good adherence and early efficacy using desonide hydrogel for atopic dermatitis: Results from a program addressing patient compliance","volume":"9","author":"Yentzer","year":"2010","journal-title":"J. Drugs Dermatol."},{"key":"ref_75","first-page":"26","article-title":"A 6% benzoyl peroxide foaming cloth cleanser used in the treatment of acne vulgaris: Aesthetic characteristics, patient preference considerations, and impact on compliance with treatment","volume":"2","year":"2009","journal-title":"J. Clin. Aesthet. Dermatol."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1001\/jamadermatol.2017.6144","article-title":"The Role of the Physician in Patient Perceptions of Barriers to Primary Adherence with Acne Medications","volume":"154","author":"Ryskina","year":"2018","journal-title":"JAMA Dermatol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1046\/j.1365-2133.2000.03831.x","article-title":"Psychiatric morbidity in dermatological outpatients: An issue to be recognized","volume":"143","author":"Picardi","year":"2000","journal-title":"Br. J. Dermatol."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.2147\/PPA.S117437","article-title":"Interventions to increase adherence to acne treatment","volume":"10","author":"Alexander","year":"2016","journal-title":"Patient Prefer. Adherence"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5152\/pcp.2024.23702","article-title":"Exploring the Effects of Repetitive Transcranial Magnetic Stimulation on CoMorbid Sleep Disorders in Preschool Children with Attention-Deficit Hyperactivity Disorder","volume":"34","author":"Yilin","year":"2024","journal-title":"Psychiatry Clin. Psychopharmacol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.2147\/CCID.S335007","article-title":"The Effect of Depression on Treatment Adherence Among a Sample of Saudi Patients Diagnosed with Acne Vulgaris","volume":"14","author":"Alghofaili","year":"2021","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"4094","DOI":"10.1111\/jocd.16589","article-title":"Development and Validation of the Isotretinoin Hesitancy Scale for Acne Vulgaris: A Preliminary Study","volume":"23","author":"Agaoglu","year":"2024","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1080\/09546630600688515","article-title":"Adherence in dermatology: A review of the last 20 years","volume":"17","author":"Hodari","year":"2006","journal-title":"J. Dermatol. Treat."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1007\/s13555-017-0203-4","article-title":"Use of Supplementary Patient Education Material Increases Treatment Adherence and Satisfaction Among Acne Patients Receiving Adapalene 0.1%\/Benzoyl Peroxide 2.5% Gel in Primary Care Clinics: A Multicenter, Randomized, Controlled Clinical Study","volume":"7","author":"Myhill","year":"2017","journal-title":"Dermatol. Ther."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"5785","DOI":"10.5826\/dpc.1503a5785","article-title":"The Interconnection Between Dermatology and Mental Health: Exploring ADHD and Acne Treatment Adherence","volume":"15","author":"Liu","year":"2025","journal-title":"Dermatol. Pract. Concept."},{"key":"ref_85","first-page":"13","article-title":"Oral and written counseling is a useful instrument to improve short-term adherence to treatment in acne patients: A randomized controlled trial","volume":"5","author":"Nicklas","year":"2015","journal-title":"Dermatol. Pract. Concept."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s40257-016-0236-y","article-title":"The Utility of Text Message Reminders for Acne Patients: A Pilot Study","volume":"18","author":"Okhovat","year":"2016","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_87","first-page":"4","article-title":"The noncompliant patient with acne","volume":"16","author":"Tanghetti","year":"2011","journal-title":"Ski. Ther. Lett."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.36849\/JDD.9196","article-title":"NECASA II: A Practical Algorithm Integrating Skincare in the Management of Adult Female Acne in the Nordic European Countries","volume":"24","author":"Bjerring","year":"2025","journal-title":"J. Drugs Dermatol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1080\/09546634.2017.1342758","article-title":"Combination of benzoyl peroxide 5% gel with liquid cleanser and moisturizer SPF 30 in acne treatment results in high levels of subject satisfaction, good adherence and favorable tolerability","volume":"29","author":"Kim","year":"2017","journal-title":"J. Dermatol. Treat."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"7814","DOI":"10.1097\/MS9.0000000000003932","article-title":"Desloratadine as an adjunct to isotretinoin: Enhancing tolerability and adherence in acne management","volume":"87","author":"Qazi","year":"2025","journal-title":"Ann. Med. Surg."},{"key":"ref_91","doi-asserted-by":"crossref","unstructured":"Wo\u017ana, J., Ba\u0142oniak, A., St\u0119pka, J., Pola\u0144ska, A., Mojs, E., and \u017baba, R. (2025). Efficacy of Combined Oral Isotretinoin and Desloratadine or Levocetirizine vs. Isotretinoin Monotherapy in Treating Acne Vulgaris: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biomedicines, 13.","DOI":"10.3390\/biomedicines13081847"},{"key":"ref_92","first-page":"412","article-title":"Comparative study of stress and quality of life in outpatients consulting for different dermatoses in 5 academic departments of dermatology","volume":"18","author":"Misery","year":"2008","journal-title":"Eur. J. Dermatol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1111\/j.1365-4632.2011.05409.x","article-title":"High-dose isotretinoin in acne vulgaris: Improved treatment outcomes and quality of life","volume":"51","author":"Cyrulnik","year":"2012","journal-title":"Int. J. Dermatol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1111\/jdv.14585","article-title":"Quality of life measurement in acne. Position Paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa","volume":"32","author":"Chernyshov","year":"2017","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"6815","DOI":"10.1111\/jocd.15268","article-title":"Facial acne causes stigmatization among adolescents: A cross-sectional study","volume":"21","author":"Szepietowska","year":"2022","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e016964","DOI":"10.1136\/bmjopen-2017-016964","article-title":"Help-seeking behaviours, opportunistic treatment and psychological implications of adolescent acne: Cross-sectional studies in schools and hospital outpatient departments in the UK","volume":"7","author":"Desai","year":"2017","journal-title":"BMJ Open"},{"key":"ref_97","first-page":"adv00051","article-title":"Psychosocial Aspects of Adult Acne: Data from 13 European Countries","volume":"100","author":"Altunay","year":"2020","journal-title":"Acta Derm.-Venereol."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s40257-021-00628-1","article-title":"Impact of Facial Atrophic Acne Scars on Quality of Life: A Multi-country Population-Based Survey","volume":"23","author":"Tan","year":"2021","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1590\/abd1806-4841.201533726","article-title":"Quality of life, self-esteem and psychosocial factors in adolescents with acne vulgaris","volume":"90","author":"Vilar","year":"2015","journal-title":"An. Bras. Dermatol."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.5114\/ada.2021.112765","article-title":"Prevalence and quality of life of facial acne: A cross-sectional study in high school students in Poland","volume":"39","author":"Szepietowska","year":"2022","journal-title":"Adv. Dermatol. Allergol."},{"key":"ref_101","first-page":"121","article-title":"Impact of acne vulgaris on quality of life and self-esteem","volume":"98","author":"Hosthota","year":"2016","journal-title":"Cutis"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"20160035","DOI":"10.1515\/ijamh-2016-0035","article-title":"Evaluation of social anxiety, self-esteem, life quality in adolescents with acne vulgaris","volume":"30","author":"Unal","year":"2016","journal-title":"Int. J. Adolesc. Med. Health"},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Kelly, K.A., Balogh, E.A., Kaplan, S.G., and Feldman, S.R. (2021). Skin Disease in Children: Effects on Quality of Life, Stigmatization, Bullying, and Suicide Risk in Pediatric Acne, Atopic Dermatitis, and Psoriasis Patients. Children, 8.","DOI":"10.3390\/children8111057"},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"\u0110urovi\u0107, M.R., \u0110urovi\u0107, M., Jankovi\u0107, J., and Jankovi\u0107, S. (2021). Quality of life in Montenegrin pupils with acne. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0250155"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"204","DOI":"10.2310\/7750.2009.08055","article-title":"Effect of Quality of Life Impact and Clinical Severity on Adherence to Topical Acne Treatment","volume":"13","author":"Tan","year":"2009","journal-title":"J. Cutan. Med. Surg."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"21084","DOI":"10.1038\/s41598-023-48182-6","article-title":"Understanding the impact of acne vulgaris and associated psychological distress on self-esteem and quality of life via regression modeling with CADI, DLQI, and WHOQoL","volume":"13","author":"Morshed","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"646","DOI":"10.5152\/TurkArchPediatr.2023.23111","article-title":"The Relationship Between Adolescents\u2019 Perception of Family Emotional Atmosphere and Acne Severity, Self-Esteem, and Quality of Life in Adolescents Diagnosed with Acne Vulgaris","volume":"58","author":"Guler","year":"2023","journal-title":"Turk. Arch. Pediatr."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"93","DOI":"10.4103\/ijd.ijd_342_21","article-title":"Assessment of Body Image Disturbance, Self-Esteem and Quality of Life among Adolescents and Young Adults with Acne in a Tertiary Care Facility of India","volume":"67","author":"Gudiya","year":"2022","journal-title":"Indian J. Dermatol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"210","DOI":"10.14744\/SEMB.2024.38268","article-title":"Evaluation of Depression, Self-esteem, Anxiety, and Dermatological Quality of Life Index in Adolescent Acne Patients: A Case-Control Study","volume":"58","author":"Kazan","year":"2024","journal-title":"SiSli Etfal H\u00e4st. Tip. Bul. Med. Bull. Sisli Hosp."},{"key":"ref_110","first-page":"e52586","article-title":"Impact of Acne Vulgaris and Vitiligo on Quality of Life and Self-Esteem in the Patient Population of Madinah, Saudi Arabia","volume":"16","author":"Alfahl","year":"2024","journal-title":"Cureus"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1177\/12034754221119496","article-title":"The Social and Psychological Impact of Acne Treatment: A Cross-Sectional Study of Blood Donors","volume":"26","author":"Andersen","year":"2022","journal-title":"J. Cutan. Med. Surg."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/j.1365-2230.1994.tb01167.x","article-title":"Dermatology Life Quality Index (DLQI)-a simple practical measure for routine clinical use","volume":"19","author":"Finlay","year":"1994","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1111\/bjd.20391","article-title":"Clinical experience and psychometric properties of the Cardiff Acne Disability Index (CADI)","volume":"185","author":"Abdelrazik","year":"2021","journal-title":"Br. J. Dermatol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1093\/ced\/llae453","article-title":"Acne-related quality of life and mental health among adolescents: A cross-sectional analysis","volume":"50","author":"Dumont","year":"2024","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.det.2011.11.003","article-title":"The Skindex Instruments to Measure the Effects of Skin Disease on Quality of Life","volume":"30","author":"Chren","year":"2012","journal-title":"Dermatol. Clin."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jdin.2024.03.007","article-title":"Development of the acne-specific quality of life questionnaire Quality of Life Relevance-Acne","volume":"16","author":"Chernyshov","year":"2024","journal-title":"JAAD Int."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1023\/B:QURE.0000018486.91360.00","article-title":"The World Health Organization\u2019s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A Report from the WHOQOL Group","volume":"13","author":"Skevington","year":"2004","journal-title":"Qual. Life Res."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.ijwd.2017.10.004","article-title":"How Acne Bumps Cause the Blues: The Influence of Acne Vulgaris on Self-Esteem","volume":"4","author":"Gallitano","year":"2018","journal-title":"Int. J. Women\u2019s Dermatol."},{"key":"ref_119","first-page":"916","article-title":"The evaluation of psychiatric comorbidity, self-injurious behavior, suicide probability, and other associated psychiatric factors (lonileness, self-esteem, life satisfaction) in adolescents with acne: A clinical pilot study","volume":"18","author":"Aktepe","year":"2018","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/pde.12802","article-title":"Psychodermatologic Effects of Atopic Dermatitis and Acne: A Review on Self-Esteem and Identity","volume":"33","author":"Nguyen","year":"2016","journal-title":"Pediatr. Dermatol."},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"Kostecka, M., Kostecka, J., Szwed-Gu\u0142aga, O., Jackowska, I., and Kostecka-Jarecka, J. (2022). The Impact of Common Acne on the Well-Being of Young People Aged 15\u201335 Years and the Influence of Nutrition Knowledge and Diet on Acne Development. Nutrients, 14.","DOI":"10.3390\/nu14245293"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"245","DOI":"10.2147\/CCID.S158129","article-title":"The impact of acne and facial post-inflammatory hyperpigmentation on quality of life and self-esteem of newly admitted Nigerian undergraduates","volume":"11","author":"Akinboro","year":"2018","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1111\/j.1471-6712.2007.00547.x","article-title":"Experiences of appearance-related teasing and bullying in skin diseases and their psychological sequelae: Results of a qualitative study","volume":"22","author":"Magin","year":"2008","journal-title":"Scand. J. Caring Sci."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1080\/13548506.2025.2465655","article-title":"Acne, self-esteem, and mental health: A scoping review","volume":"31","author":"Faro","year":"2025","journal-title":"Psychol. Health Med."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1080\/02673843.2001.9747871","article-title":"Normative Data and Mental Health Construct Validity for the Rosenberg Self-Esteem Scale in British Adolescents","volume":"9","author":"Bagley","year":"2001","journal-title":"Int. J. Adolesc. Youth"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1002\/1097-4679(197801)34:1<72::AID-JCLP2270340115>3.0.CO;2-T","article-title":"The coopersmith self-esteem inventory: Analysis and partial validation of a modified adult form","volume":"34","author":"Myhill","year":"1978","journal-title":"J. Clin. Psychol."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"510","DOI":"10.3390\/clockssleep1040039","article-title":"Acne Severity and Sleep Quality in Adults","volume":"1","author":"Schrom","year":"2019","journal-title":"Clocks Sleep"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"5530","DOI":"10.5826\/dpc.1504a5530","article-title":"Sleep Disturbances and Acne: A Comprehensive Review","volume":"15","author":"Samaniego","year":"2025","journal-title":"Dermatol. Pract. Concept."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1007\/s11325-023-02777-5","article-title":"Sleep quality, circadian preferences, and mood among patients with acne vulgaris: A case\u2013control study","volume":"27","author":"Zhu","year":"2023","journal-title":"Sleep Breath"},{"key":"ref_130","doi-asserted-by":"crossref","unstructured":"Chi, Y., Yang, X., Deng, D., Li, P., and Zhang, Y. (2025). Polymorphisms in MTNR1A (rs2119882) and CLOCK (rs1801260) genes are associated with facial acne susceptibility in gas station workers. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0329150"},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1007\/s00403-025-03994-6","article-title":"Effect of isotretinoin treatment on sleep quality in acne vulgaris patients","volume":"317","author":"Celik","year":"2025","journal-title":"Arch. Dermatol. Res."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/ASW.0000000000000187","article-title":"Isotretinoin-Induced Hypersomnia: A Cross-sectional Study and Literature Review","volume":"37","author":"Shawky","year":"2024","journal-title":"Adv. Ski. Wound Care"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"e133","DOI":"10.1111\/ijd.17232","article-title":"Isotretinoin-associated vivid dreams during acne therapy","volume":"63","author":"Choe","year":"2024","journal-title":"Int. J. Dermatol."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1111\/jdv.70345","article-title":"Association of lifestyles and mental health with adult acne: A population-based cross-sectional study","volume":"40","author":"He","year":"2026","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.smrv.2015.01.009","article-title":"The Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: A systematic review and meta-analysis","volume":"25","author":"Mollayeva","year":"2016","journal-title":"Sleep Med. Rev."},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.sleep.2023.07.008","article-title":"Epworth sleepiness scale: A meta-analytic study on the internal consistency","volume":"109","author":"Malafaia","year":"2023","journal-title":"Sleep Med."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/0191-8869(91)90110-W","article-title":"Horne & \u00d6stberg morningness-eveningness questionnaire: A reduced scale","volume":"12","author":"Adan","year":"1991","journal-title":"Pers. Individ. Differ."},{"key":"ref_138","first-page":"17nr02247","article-title":"Psychiatric and Psychological Impact of Chronic Skin Disease","volume":"20","author":"Jafferany","year":"2018","journal-title":"Prim. Care Companion J. Clin. Psychiatry"},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"3223","DOI":"10.2147\/CCID.S545766","article-title":"The Psychological Journey of Patients with Atrophic Acne Scarring: A Qualitative Study Based on Uncertainty in Illness Theory","volume":"18","author":"Li","year":"2025","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_140","doi-asserted-by":"crossref","unstructured":"Szepietowska, M., Stefaniak, A.A., Krajewski, P.K., and Matusiak, L. (2023). Females May Have Less Severe Acne, but They Suffer More: A Prospective Cross-Sectional Study on Psychosocial Consequences in 104 Consecutive Polish Acne Patients. J. Clin. Med., 13.","DOI":"10.3390\/jcm13010004"},{"key":"ref_141","first-page":"18","article-title":"Perceptions and psychosocial judgement of patients with acne vulgaris","volume":"75","author":"Loh","year":"2020","journal-title":"Med. J. Malays."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1111\/j.1525-1470.1991.tb00945.x","article-title":"The Psychosocial Effects of Acne on Adolescents","volume":"8","author":"Krowchuk","year":"1991","journal-title":"Pediatr. Dermatol."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1001\/jamadermatol.2022.2742","article-title":"Projective Personification Approach to the Experience of People with Acne and Acne Scarring\u2014Expressing the Unspoken","volume":"158","author":"Tan","year":"2022","journal-title":"JAMA Dermatol."},{"key":"ref_144","first-page":"e78734","article-title":"Prevalence of Anxiety and Depression in Pakistani Patients with Acne Vulgaris","volume":"17","author":"Jamil","year":"2025","journal-title":"Cureus"},{"key":"ref_145","doi-asserted-by":"crossref","unstructured":"Szepietowska, M., Bie\u0144, B., Krajewski, P.K., Stefaniak, A.A., and Matusiak, \u0141. (2023). Prevalence, Intensity and Psychosocial Burden of Acne Itch: Two Different Cohorts Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12123997"},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s00403-025-04123-z","article-title":"Severity of acne vulgaris predicts maladaptive psychosocial perceptions and neuropsychiatric disorders: A case-control study","volume":"317","author":"Woodie","year":"2025","journal-title":"Arch. Dermatol. Res."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"5053","DOI":"10.5826\/dpc.1502a5053","article-title":"Assessment of Eating Attitude and Psychiatric Parameters in Patients with Acne Vulgaris","volume":"15","author":"Kaya","year":"2025","journal-title":"Dermatol. Pract. Concept."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"349","DOI":"10.2147\/CCID.S451927","article-title":"Anhedonia in Acne Vulgaris: A Cross-Sectional Study of 104 Consecutive Acne Patients","volume":"17","author":"Szepietowska","year":"2024","journal-title":"Clin. Cosmet. Investig. Dermatol."},{"key":"ref_149","first-page":"783","article-title":"Sexual dysfunction in female patients with acne vulgaris\u2014A questionnaire-based survey","volume":"91","author":"Karny","year":"2025","journal-title":"Indian J. Dermatol. Venereol. Leprol."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"684","DOI":"10.5114\/ada.2023.129944","article-title":"Alexithymia prevalence among patients with chronic dermatological diseases in a tertiary hospital, Saudi Arabia","volume":"40","author":"Alfahaad","year":"2023","journal-title":"Adv. Dermatol. Allergol."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/jdv.15954","article-title":"Body dysmorphic disorder in patients with acne: A multicentre study","volume":"34","author":"Marron","year":"2019","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"221","DOI":"10.5114\/ada.2022.113616","article-title":"Body dysmorphic disorder in patients with acne: Treatment challenges","volume":"39","author":"Kobusiewicz","year":"2022","journal-title":"Adv. Dermatol. Allergol."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/bjd.13749","article-title":"Psychological impact of acne on 21st-century adolescents: Decoding for better care","volume":"172","author":"Revol","year":"2015","journal-title":"Br. J. 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