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Perry, who is now 44, is one of many sufferers of skin dysmorphia, more commonly referred to as acne dysmorphia in the US, 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 stunned,” she reflects. “My skin looked normal – good, even. I asked former classmates about it, and they told me they never noticed my skin being bad.
“I was shocked. I had always believed I would be remembered as the girl with terrible acne.”
Skin dysmorphia is an increasingly recognised condition, where the sufferer looks in the mirror and believes there are imperfections all over their face. This can lead to an obsessive and complex skincare routine in a bid to achieve the type of flawless skin commonly flaunted (thanks to filters and foundation) on social media sites like TikTok and Instagram Reels.
Signs of the condition include checking in the mirror excessively, being dissatisfied with aesthetic or medical skin treatments, compulsively using or trying new products and procedures, experiencing intense emotional stress over minor or invisible skin issues, and even avoiding social situations because of the way you think your skin looks.
The all-encompassing illness often appears alongside depression, anxiety, isolation, and loss of work or low grades, as sufferers get stuck in a loop of staring at the face they hate in the mirror, picking apart their reflection and trying to “fix” it – through whatever dangerous or costly means they can.
“The emotional and financial costs were enormous,” says Perry. “I have likely spent tens of thousands of dollars on skincare.”
Excessive skincare routines, with numerous steps, active agents or excessive scraping and scrubbing, are often adopted by skin dysmorphia sufferers and can expose people to a myriad of health risks, including scarring, irritation, and sun damage – or worse.
In one case, a previously healthy 44-year-old woman suffered a seizure and liver toxicity hepatitis, which, researchers concluded, stemmed from prolonged exposure to titanium dioxide in her skincare products.
While this is an extreme case, it’s not uncommon for fears over acne to keep patients hooked on intense treatments for far longer than necessary.
Maddie Ogle, 22, was put on 150mg of spironolactone for her hormonal acne when she was 20. The medication – a diuretic, which can cause dizziness, low energy, skin rashes, headaches and loss of libido – cleared her skin, but she became too afraid to come off of it, even though by this point she’d been weaned down to 20mg as her treatment came to a close.
Maddie Ogle has shared her experience with skin dysmorphia on TikTok (TikTok/@maddieogle10)
“I kept having all these side effects,” she says. “But my skin looked good, so I thought I’d rather deal with a few weird things than the depression of having acne. I would get tiny breakouts and be convinced it was happening again.
“I’m glad that I had my mum and my boyfriend around me to tell me you need to care about your health and your mental health more than your skin because it’s going to be fine and it, and it was, so I’m glad I listened to them,” she reflects of her decision to come off of the medication and see how her skin responded (well).
“I was just exhausted; 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 involving intense, obsessive preoccupation with imagined or slight flaws in physical appearance that are often unnoticeable to others. This can mean that those suffering from skin dysmorphia are less likely to get the help they need, as patients will often go to dermatologists to treat their perceived skin issues, rather than seeking mental health support.
It deeply impacted my self-esteem and self-worth and made me more vulnerable to abusive relationships
“The psychological effects deeply impacted my self-esteem and self-worth and made me more vulnerable to abusive relationships,” Perry reflects about her own symptoms.
Awareness of the condition is growing. In January 2026, doctors recommended that further steps be taken for the symptoms to be identified, through a new Skin Dysmorphia Scale (SDS) published in the Journal of Cosmetic Dermatology, to “urgently necessitate” comprehensive assessment and management of the condition. However, it’s still up to practitioners whether or not they use it.
The psychologist and mental health researcher Dr Eleanor Chatburn says she’d like to see more communication between dermatologists, aesthetic practitioners and mental health specialists to stop people falling through the cracks. “I have worked with dermatologists before who are very ethical,” she says. “They’ll screen for dysmorphia and decline to treat people who have it or refer them first to a psychologist. But there are also plenty of people who will happily take people’s money and offer them a whole course of various treatments.”
She points out that alerting a patient that they might be suffering from a mental health issue can be a hard conversation to have. “People can still be in the mindset that it’s definitely a skin problem,” says Chatburn. “They’re going to a dermatologist or aesthetic practitioner because they want a quick, external fix. If they hear, ‘this may not be fixable in the way you think it is,’ some people don’t come back because they desperately want a certain product or laser treatment. So, they find someone who’ll sell it to them.”
Chatburn advises anyone wondering if they are suffering from the condition to “do an audit”. Ask others around you whether you spend a lot of your day checking yourself in the mirror. Ask yourself if you are spending a lot of your money on skin products and a lot of your time on social media comparing yourself to flawless influencers. Think about how those things are impacting your life.
Those who suffer will often spend less time socialising, dismiss their hobbies, and decrease the amount they go outside. “There’ll be a whole bunch of stuff they’re avoiding,” Chatburn says. “Sitting under bright lights, being too close to people; things that we call ‘safety behaviours’ because they make sufferers feel secure, but actually they can inadvertently keep the preoccupation going.
“Also look for signs of low mood, depression, hopelessness, and low self-esteem. I’ve heard people say, ‘My skin is bad, so I’m bad.’ So, it gets internalised in a really, really toxic way.”
Excessive skincare purchasing is worse now than ever before. Nurse Liberos, a registered nurse prescriber and aesthetic practitioner based in London, says she’s often “horrified” by patients who come to see her with 50 different highly chemical products in their bathroom. “It’s ridiculous,” she says. “I’ll give them three that are less toxic and then also look at their overall wellbeing; mental health, internal health, gut health, blood tests, because that all links to your skin.
“Skin is the largest organ of your body, so you’ve got to look at everything – but there are practitioners out there who’re just trying to sell products.”
As well as selling products, there are a lot of people selling what looks like perfect skin. With 47.6 million videos (and counting) under the “skincare” hashtag on TikTok, it’s no wonder that the latest research demonstrates that heavier use of the app coincides with higher skin dysmorphia tendencies.
“Don’t forget, children have access to TikTok, Instagram, Boots and Superdrug,” Liberos reminds us of Gen Alpha’s insatiable penchant for products. “There are harmful, harsh ingredients in there that are dangerous to children; you can pick anything up and take it to the counter.”
If you are experiencing feelings of distress or are struggling to cope, you can speak to the Samaritans, in confidence, on 116 123 (UK and ROI), email jo@samaritans.org, or visit the Samaritans website to find details of your nearest branch