Background Decisions about effective treatment and referral of patients with acne vulgaris can be complicated by psychosocial effects on patients. Objective The aim of this study was to investigate the complexities of diagnosis, treatment and referral decisions for general practitioners (GPs) providing care to patients with acne. Methods A qualitative descriptive study collected data via telephone interviews with 20 purposively sampled GPs working in New South Wales. A thematic analysis guided by the study objectives was undertaken. Results The participating GPs had divergent management approaches to acne treatment, infrequently provided acne patients with written resources, and would value additional dermatological support. Furthermore, the GPs recognised psychosocial ramifications and patient distress as drivers for treatment and expedited referral to dermatologists. Discussion Avenues for improved patient outcomes include explicit attention to psychological morbidity beyond treatment of the acne itself and improved use of patient educational materials, along with consistent collaboration between GPs and dermatologists.