To describe the psychosocial impact of acne on adolescents, and, in particular, to assess whether self-concept is affected by medical treatment, we evaluated 39 teenagers presenting for care to a community-based dermatologist. Prior to and following treatment, subjects completed a self-assessment questionnaire, the Piers-Harris self-concept scale, and underwent an objective assessment of acne severity. Fifty-eight percent of subjects were dissatisfied with their facial appearance and this in turn was correlated with feelings of embarrassment and social inhibition (for each, r = 0.48, P less than or equal to 0.005). Subjects' rating of acne severity, but not the dermatologist's, was correlated with dissatisfaction with facial appearance (r = 0.45, P less than or equal to 0.005). Despite these findings, the mean Piers-Harris total t-score (55.4 +/- 7.4) was within the normal range. Fourteen subjects (36%) returned for follow-up and 71% of these were judged by both the dermatologist and themselves to have improved. Following therapy, significant reductions in the adverse consequences of acne were observed with 42% of subjects reporting that their facial appearance was more acceptable to peers, 50% being less embarrassed, and 58% feeling less socially inhibited. Minimal improvement in mean Piers-Harris total t-score was observed (54.6 to 57.4, P = 0.004, paired t-test). Our data demonstrate that acne is perceived by adolescents to have important negative personal and social consequences, and that improvement in these areas may accompany medical treatment.