Adult acne is a common and recurrent skin disease, which is significantly associated with psychological comorbidities such as appearance anxiety and depression. Approximately 35% to 50% of acne patients have comorbid body image disturbance, their risk of depression is 2 to 3 times higher than that of healthy people, and the incidence of suicidal ideation is even 4.5 times that of the general population. This bidirectional influence mechanism has been explained by the skin-brain axis theory. Inflammatory factors of acne (such as IL-6 and TNF-α) can cross the blood-brain barrier, directly act on the hypothalamic-pituitary-adrenal axis, and induce anxiety and depression; while psychological stress exacerbates sebum secretion and inflammatory response through neuroendocrine pathways, forming a vicious circle. This paper aims to systematically review the research progress on adult acne complicated with appearance anxiety and depression, so as to provide evidence-based basis for clinical practice.