Acne is highly visible, sits on the part of the body people look at when they talk to you, and typically arrives during adolescence, when social feedback matters most. The association with anxiety, depression, social withdrawal and reduced self-esteem is well documented.
NICE's acne guideline covers the impact of acne on mental health and wellbeing as part of management. It is not an optional extra to the clinical picture.
The 2026 Change
NG198 was updated in August 2026, and one of the amendments is directly relevant here: when considering oral isotretinoin, the guidance now says to take into account the person's psychological wellbeing, and to refer them to mental health services before starting treatment if appropriate.
The reasoning cuts both ways. Psychological distress is one of the reasons to treat acne aggressively rather than wait. It is also something that needs assessing and supporting in its own right before starting a medicine with recognised psychiatric warnings.
Isotretinoin and Mood
Psychiatric side effects, including depression and suicidal thoughts, have been reported with isotretinoin. The causal picture is genuinely difficult to untangle: severe acne itself causes significant distress, and the age group treated is one in which mental illness commonly first presents.
What the MHRA has done is require that the risk be actively managed rather than debated. Patients should be asked about mental health at follow-up appointments, and patients and those around them should be alert to changes in mood. A patient information video produced by the British Association of Dermatologists forms part of the current risk minimisation measures.
If mood changes occur, report them promptly rather than waiting them out.
Tell Someone Close to You
This is the practical step that matters most. Mood change is frequently more visible to family or partners than to the person experiencing it. The same logic sits behind the finasteride patient alert card, which is explicitly designed to be shared.
Telling one person "I have started this, and low mood is a recognised side effect — say something if I seem different" costs nothing and is the most effective monitoring available.
What to Raise in a Consultation
Say explicitly how the acne is affecting you. Not because it is required, but because it changes decisions:
- Whether to treat now or watch and wait
- How quickly to escalate if a treatment is not working
- Whether a referral is justified
- Whether isotretinoin is appropriate, and what support should be in place alongside it
Concrete examples land better than general statements: avoiding photographs, not going swimming, sitting differently in class, cancelling plans.
If You Are Struggling
Support for the psychological impact exists independently of the acne treatment. Your GP can refer you, NHS talking therapies can be self-referred to in England, and dermatology services in some areas have psychological support attached.
If you are having thoughts of harming yourself, contact your GP, NHS 111, or the Samaritans on 116 123, which is free and available at any hour. If you are taking isotretinoin or finasteride, say so — it is directly relevant information.
The Wider Point
Acne treatment that only looks at the skin is treating half the condition. If a service assessing you has not asked at any point how the acne is affecting you, that is a gap — and it is the gap that determines whether treatment gets escalated when it should.