BACKGROUND: The association of acne and self-evaluation is barely explored among late adolescents in the general population. OBJECTIVE: We sought to explore self-esteem, body satisfaction, and acne among 18-year-old young adults at a community level. METHODS: We conducted a questionnaire-based survey among 3775 late adolescents. RESULTS: Our response rate was 80%. The prevalence of acne was 13.5%. Girls and boys with acne had significantly more depressive symptoms, lower self-attitude, more feelings of uselessness, fewer feelings of pride, lower self-worth, and lower body satisfaction than those without acne. In a regression model adjusting for body mass index and depressive symptoms, acne explained significantly poor self-attitude for boys only (odds ratio 2.07 [confidence interval 1.10; 3.88]) and poor self-worth for girls only (odds ratio 1.88 [confidence interval 1.23; 2.88]). LIMITATIONS: Not all items of the self-esteem instrument were included. CONCLUSIONS: At age 18 years, acne is related to self-evaluation independent of body mass index and depressive symptoms.