The authors present the case of a 36-year-old female patient whose preoccupation with a dermatologic malady escalated into a serious psychiatric disorder. Although the subject’s skin changes were noticeable only under close scrutiny, she quit her job, became despondent about her acne & developed suicidal ideation. The diagnosis & treatment of this patient allow a broader discussion of the somatically focused patient whose ideation reaches delusional intensity. (14 refs.)