Psychodermatology Profiles in Acne Vulgaris: Quality of Life, Stress, Insomnia, and Depressive Symptoms in a Cross-Sectional Cohort

Background/Objectives: Acne vulgaris can impair quality of life (QoL) beyond lesion burden, and distress, insomnia, and stress may co-occur. We compared patient-reported burden across treatment-intensity groups used as pragmatic proxies of disease burden and management complexity, quantified associations between clinical severity and psychosocial measures, and modeled predictors of high QoL impairment. Methods: Cross-sectional outpatient study (N = 97) in Timișoara, Romania. Severity was assessed using the Global Acne Grading System (GAGS) and scarring grade (0–3). Participants completed Romanian-language versions of the Dermatology Life Quality Index (DLQI), Cardiff Acne Disability Index (CADI), Patient Health Questionnaire-9 (PHQ-9), Insomnia Severity Index (ISI), and Perceived Stress Scale-10 (PSS-10). Group comparisons used analysis of variance (ANOVA)/Kruskal–Wallis and chi-square tests; associations used Spearman correlations. Multivariable ordinary least squares (OLS) regression modeled DLQI; penalized logistic regression modeled DLQI ≥ 11. Treatment intensity was analyzed as a descriptive stratification variable rather than as an independent exposure, and a prespecified sensitivity analysis re-examined the DLQI gradient after adjustment for GAGS and scarring grade. The DLQI ≥ 11 cut-off was prespecified from validated DLQI banding. Clustering, mediation, and network analyses were exploratory and hypothesis-generating in view of the modest sample size. Results: DLQI differed across treatment intensity strata (topical only: 11.1 ± 5.7, oral antibiotic + topical: 16.9 ± 7.6, isotretinoin: 20.4 ± 7.1; p < 0.001). High impairment (DLQI ≥ 11) occurred in topical only: 40.6%, oral antibiotic + topical: 78.8%, isotretinoin: 87.5% (overall 69.1%; p < 0.001). DLQI correlated with PHQ-9 (ρ = 0.59), ISI (ρ = 0.49), and PSS-10 (ρ = 0.60) (all p < 0.001). In multivariable analysis, GAGS (B 0.35, p < 0.001), PHQ-9 (B 0.27, p = 0.017), and PSS-10 (B 0.24, p = 0.007) independently predicted DLQI. The combined predictive model achieved an area under the curve (AUC) of 0.841 (5-fold cross-validation, CV) for identifying DLQI ≥ 11. Conclusions: In this Romanian outpatient cohort, psychosocial measures explained substantial variability in acne-related disability alongside clinical severity. These cross-sectional findings support brief integrated screening and suggest that higher-burden treatment strata merit particular psychosocial attention, but they should not be interpreted as evidence that treatment intensity itself independently causes worse mental health outcomes. The contribution of this work lies less in confirming known associations than in quantifying, in an under-represented eastern European outpatient setting, how much of the identification of high-impact patients depends on patient-reported rather than lesion-based information.