Abstract
Acne vulgaris requires sustained treatment, yet adherence may weaken before meaningful improvement occurs, particularly when topical therapy causes xerosis, peeling, erythema, or stinging. Digital acne content can expand access to education and patient perspectives, but it also places clinical advice beside commercial claims, transformation narratives, and complex skincare routines without a consistent hierarchy of evidence. This narrative review examined evidence relevant to how psychodermatological vulnerability and digital skincare exposure may contribute to cosmetic self-experimentation, cutaneous irritation, and treatment non-adherence, while distinguishing observed associations from untested mechanistic links. This digital exposure includes exposure to online acne/skincare recommendations, social media advice, influencer content, transformation narratives, and algorithmically reinforced skincare-routine content. PubMed, Embase, and Google Scholar were searched through July 22, 2026, for English-language literature published since 2016. Across the reviewed literature, acne-related stigma, depressive symptoms, body dysmorphic symptoms, and treatment expectations were associated with psychological burden, treatment satisfaction, and intention to adhere. Separate studies also described patient uptake of online acne recommendations, clinician-observed dermatoses associated with multi-step cosmetic routines, and associations between cutaneous adverse effects and poorer medication adherence. Together, these findings support a conceptual model in which psychodermatological distress, delayed improvement, online product exposure, cutaneous symptoms, and adherence difficulties may interact, but the available evidence does not establish this sequence causally or longitudinally. No longitudinal study measured digital exposure, product additions, objective barrier change, symptom attribution, and medication persistence in the same patients. Acne care should therefore emphasize realistic treatment timelines, application demonstration, regimen simplification, early follow-up, and detailed review of prescribed and non-prescribed products. These findings do not justify treating all digital content or non-prescription skincare as harmful. Clinician-produced content may support patient education, and selected dermocosmetics may have a role as adjuncts to structured acne care.