pArie, now 44, is one of the many sufferers of skin dysmorphia, also known as adolescent dysmorphia, in the United States, where she lives in New Orleans, Louisiana. “Years later, a friend found an old photo of us – taken before Photoshop and filters existed – and I was amazed,” he reflects. “My skin looked normal—well, even. I asked former classmates about it, and they told me they’d never seen my skin worse.
“I was surprised, I always believed I would be remembered as the girl with the acne.”
Skin dysmorphia is an increasingly recognized condition where the patient looks in the mirror and believes that there are flaws in their face. This can lead to sensitive and complicated skin care routines in a bid to achieve the kind of flawless skin (thanks to filters and foundation) on social media sites like TikTok and Instagram feeds.
Symptoms of the condition include looking extensively in the mirror, being dissatisfied with beauty or medical skin treatments, compulsively using or trying new products and procedures, experiencing intense emotional stress over small or invisible skin issues, and even avoiding social situations because of the way you think your skin looks.
The omnipresence often manifests with anxiety, depression, isolation and loss of work or downgrading, as sufferers get stuck looking at the face they hate in the mirror, isolate their reflection and try to “fix” it – by whatever dangerous or expensive means they can.
“The emotional and financial costs were enormous,” Perry says. “I’ve probably spent tens of thousands of dollars on skin care.”
Excessive skin care routines, with too many steps, active agents or excessive scraping and scrubbing, are often adopted by patients with skin dysmorphia and can expose people to countless health risks, including scarring, irritation, and sun damage – or worse.
In one case, a previously healthy 44-year-old woman suffered from constipation and liver-toxic hepatitis, which researchers concluded was caused by long-term exposure to titanium dioxide in her skin care products.
While this is a more extreme case, it is not uncommon for fears about acne to keep patients exposed to longer-term treatments than necessary.
Maddie Ogle, 22, took 150 mg of spironolactone for her hormonal acne when she was 20 years old. The medication—a diuretic that can cause nausea, low energy, skin rashes, headaches and loss of libido—cleared her skin, but she was too scared to come off it, even though we came close to treating her.
“I had all these side effects,” she says. “But my skin looked fine, so I figured I’d better deal with a few weird things than the frustration of having acne. I’d get a small breakout and be sure it would happen again.
“I’m glad that my mother and my friend were around me who told me that you need to take care of your health and mental health more than your skin because it will be better and it is, and it was, so I’m glad I listened to them,” she reflects on her decision to come off the medication and see how her skin reacted (good).
“I was just tired; my skin was literally the only thing on my mind.”
Skin dysmorphia is a specific form of body dysmorphic disorder (BDD), a mental health condition characterized by an intense, obsessive preoccupation with perceived or slight defects in physical appearance that are often imperceptible to others. This could mean that those with skin dysmorphia are less likely to get the help they need, as patients will often go to a dermatologist for treatment of skin issues, rather than seeking mental health support.
It deeply affected my self-confidence and self-worth and made me more vulnerable to abusive relationships
“The psychological impact deeply affected my self-esteem and self-worth and made me more vulnerable to abusive relationships,” Perry reflects on her symptoms.
Awareness of the situation is developing. In January 2026, doctors recommended that more steps be taken to identify symptoms, through a new Skin Dysmorphia Scale (SDS) that Journal of Cosmetic DermatologyA comprehensive assessment and management of the situation is “urgently required”. However, it is still up to the experts whether they use it or not.
Psychologist and mental health researcher Dr Eleanor Chatburn says she would like to see more links between dermatologists, aestheticians and mental health professionals so people can fall through the cracks. “I’ve worked with dermatologists before who are very ethical,” she says. “They will screen for dysmorphia and refuse to treat people who have it or refer them to a psychologist first. But there are also a lot of people who are happy to take people’s money and offer a whole course of different treatments.”
He points out that warning a patient that they may be dealing with a mental health issue can be a difficult conversation. “People can still be in the mindset that it’s definitely a skin problem,” says Chatburn. “They go to a dermatologist or an esthetician because they want a quick, out-of-the-box solution. If they hear, ‘It might not be the way you think it can be fixed,’ some people don’t come back because they desperately want a particular product or laser treatment. So they find someone to sell them.”
Chatburn advises anyone who wonders if they may be suffering from the condition to “get it checked out”. Ask others around you if you spend most of your day checking yourself out in the mirror. Ask yourself if you spend too much of your money on skin products and too much of your time on social media comparing yourself to flawless influencers. Think about how these things affect your life.
Sufferers often spend less time socializing, cut back on their hobbies, and reduce the amount they go out. “There’s going to be a whole bunch of stuff they’re avoiding,” says Chatburn. “Sitting under bright lights, getting too close to people; things we call ‘safety behaviours’ because these patients feel safe, but in fact they may be unintentionally maintaining their busyness.
Also look for signs of low mood, depression, hopelessness, and low self-esteem. So, it gets internalized in a really, really toxic way.
Overbuying skin care is now worse than ever. Nurse Labros, a London-based registered nurse practitioner and esthetician, says she is often “horrified” by patients who come to see her with 50 different highly chemical products in their bathroom. “It’s funny,” he says. “I would give them three that are less toxic and then also look at their general well-being; mental health, internal health, gut health, blood tests, because it all has to do with your skin.
“The skin is the largest organ in your body, so you have to look at everything – but there are experts out there who are just trying to sell products.”
In addition to selling products, there are many people who have something to sell appears Like perfect skin. With 47.6 million videos (and counting) on TikTok under the “skincare” hashtag, it’s no surprise that recent research shows that heavy use of the app correlates with higher skin dysmorphia tendencies.
“Don’t forget, kids have access to TikTok, Instagram, shoes and Superdrug,” Labruse reminds us of Gen Alpha’s incredible passion for products. “It has harmful, harsh ingredients that are dangerous to children; you can take anything and take it to the counter.”
If you are experiencing feelings of anxiety or struggling to cope, you can speak to Samaritans in confidence on 116 123 (UK and ROI), email jo@samaritans.org, or visit Samaritans website to find details of your nearest branch
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