Acne is a complex and multifactorial skin disorder. Alterations in skin surface lipid (SSL) are believed to be an important factor in the pathogenesis of acne and SSL plays a key role in the initiation of acne lesions. To analyse the lipidome profiles of SSL in patients with acne and in healthy controls in order to understand SSL abnormity in acne in young men. Ultraperformance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS) and multivariate data analysis were used to investigate the SSL variations in main lipid classes, subclasses and individual species. Results showed that there were significant differences in the lipidome between the two groups. Significantly increased levels of three main classes of glycerophospholipids, fatty acyls and sterol lipids and significantly decreased levels of two main classes of prenol lipids and saccharolipids were observed in patients with acne. Subsequent analysis showed that there were 18 subclasses, which varied significantly and shared the same changing trends of the main classes to which they belonged. Multivariate data analysis indicated that 36 individual species were mostly responsible for this discrimination and the majority of differentiating lipid species were phosphatidylserines. Furthermore, it was observed that the chain length of ceramides were reduced and unsaturated free fatty acids were increased in patients with acne. SSL sampled from young male patients with acne had significantly higher levels of phosphatidylserines. Additionally, the reduction in the chain length of ceramides and the increase in unsaturated free fatty acids contributed to an altered lipid organization and decreased skin barrier function in acne.