Internalized Stigma Independently Predicts Depression in Adolescents with Acne

Adolescents with acne vulgaris are more likely to screen positive for depression than their peers, and the strength of that link appears to hinge on how much stigma they have internalized from their condition. That is the central finding of a prospective case–control study published in Archives of Dermatological Research that aimed to examine sociodemographic and clinical factors influencing depression and anxiety in adolescents with acne vulgaris and to determine whether internalized stigma represents an independent psychopathological mechanism.

The study by Esra Kiratli Nalbant, Aysun Aydin Firat, Kaan Celebier and Yildiz Hayran included 74 adolescents with acne vulgaris and 80 healthy controls. All participants completed a sociodemographic form and the Revised Children's Anxiety and Depression Scale (RCADS), which yields subscale scores including social phobia, generalized anxiety disorder and major depressive disorder. Patients with acne additionally completed the Acne Internalized Stigma Scale (AISS) and the Children's Dermatology Life Quality Index (CDLQI).

When the two groups were compared, a significantly higher proportion of adolescents with acne scored above validated cut-off values for social phobia and major depressive disorder. No significant difference emerged for generalized anxiety disorder, suggesting the psychological burden of acne in this age group is concentrated in depressive and social fears rather than in pervasive worry. In the patients with acne, factors associated with depression and anxiety were analyzed by regression.

The result was strikingly specific: internalized stigma independently predicted depression. Each one-point increase on the AISS raised the odds of major depression by 1.2-fold, with an odds ratio of 1.20 (95% confidence interval 1.08–1.33, p = 0.001). In other words, the association between acne and depressive symptoms was not simply explained by how severe the skin disease looked on paper or by demographic background; the psychological process of internalizing stigma carried its own measurable risk. The authors conclude that adolescents with acne exhibit higher depressive symptoms and that internalized stigma predicts depression irrespective of sociodemographic or clinical factors.

The study’s design deserves careful reading. As a case–control comparison with a modest sample of 154 participants, it establishes associations and statistical prediction within the studied groups rather than proving that stigma causes depression over time, and the abstract reports odds ratios rather than long-term outcomes. Even so, the identification of internalized stigma as an independent predictor is clinically meaningful, and the authors suggest that incorporating stigma awareness and brief psychological screening into dermatologic practice may enhance holistic care and improve patient outcomes.

Acne vulgaris is among the most common conditions of adolescence, a period marked by rapid physical and psychological change, and depression and anxiety are frequently reported in affected individuals. What has remained unclear, the authors note, is the underlying psychopathological mechanism. By isolating internalized stigma as an independent predictor, this study offers a concrete target for that mechanism and a rationale for treating the psychological dimension of acne as part of its medical management rather than an afterthought.

Subject of Research: Internalized stigma as an independent predictor of depression in adolescents with acne vulgaris

Article Title: Internalized stigma as an independent predictor of depression in adolescents with acne vulgaris: a prospective case–control study

Article References: Kiratli Nalbant, E., Aydin Firat, A., Celebier, K., & Hayran, Y. (2026). Internalized stigma as an independent predictor of depression in adolescents with acne vulgaris: a prospective case–control study. Archives of Dermatological Research, 318(1), Article 543. https://doi.org/10.1007/s00403-026-05020-9

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DOI: 10.1007/s00403-026-05020-9

Keywords: acne vulgaris, internalized stigma, depression, adolescents, social phobia, case-control study, dermatology, RCADS, mental health, quality of life, Internalized, stigma