Psychologic factors may play a significant role in acne in at least three ways. First, as many patients readily report, emotional stress can exacerbate acne. Second, it is common for patients to develop psychiatric problems as a consequence of the conditions, such as those related to low self-esteem, social phobias, or depression. Finally, primary psychiatric illnesses such as obsessive-compulsive disorder and psychosis may be based on a complaint that is focused on acne. In this review we hope to facilitate an understanding of how emotional factors and acne connect, and aid the dermatologist in identifying the possible presence of psychiatric problems stemming from or contributing to the disorder.