Journal of Psychiatric Insight Review

Abstract

Severe adolescent acne may have substantial psychological and social consequences, while concerns regarding isotretinoin-related adverse effects can influence treatment decisions. We describe a 13-year-old girl with severe nodulocystic acne involving approximately 60% of the face, progressing despite topical treatment and a three-month course of systemic antibiotics. The patient was socially withdrawn and minimally communicative, and psychological assessment confirmed significant emotional distress associated with peer bullying. Given the severity of the disease, treatment failure, and psychosocial burden, oral isotretinoin was recommended. Despite counselling, her parents declined treatment because of concerns regarding potential adverse effects. This case illustrates a relevant psychodermatological paradox: fear of potential treatment-related psychological harm may become a barrier to therapy while untreated acne is already causing documented psychological and social harm. Balanced counselling should therefore consider both treatment-related risks and the consequences of inadequately treated severe acne.