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Armed conflict disrupts both mental health and skin health through sustained stress and immune-related pathways, and skin disease and psychological distress can worsen each other in a continuous cycle. However, evidence from active war zones remains scarce. This study assessed psychiatric symptoms among dermatology patients during the 2023–2025 Gaza war and examined factors associated with worse mental health outcomes. A cross-sectional study enrolled 248 adults attending three governmental dermatology clinics across the Gaza Strip between 15 March and 15 June 2025. Skin diagnoses were established by the attending physician at the point of care; a trained data collector then administered the questionnaire as a structured interview, recording the DASS-21 and PCL-5 alongside disease and psychosocial characteristics. Data were analyzed using non-parametric tests, correlation analyses, and binary logistic regression, with false-discovery-rate (FDR) correction applied to bivariate disease-type comparisons and internal-consistency (Cronbach’s α) and multicollinearity (variance inflation factor, VIF) diagnostics reported for the regression models. Psychiatric symptom burden was substantial. Overall, 86.3% of participants had extremely severe anxiety, while 76.6% had severe or extremely severe depression, 76.2% had severe or extremely severe stress, and 74.2% screened positive for probable PTSD (PCL-5 ≥ 33). Skin disease severity correlated significantly with poorer scores across all psychiatric domains (r s = 0.21–0.32, all p < 0.001). Severe skin disease was independently associated with severe/extremely severe depression (OR = 2.05, 95% CI 1.10–3.80) and stress (OR = 2.05, 95% CI 1.09–3.86). Participants with dermatitis ( n = 17) reported the highest unadjusted psychiatric symptom scores across all domains, but only the depression and PCL-5 differences survived FDR correction (FDR- p = 0.041 and 0.028, respectively); the anxiety and stress differences did not (FDR- p = 0.13, 0.11) and are exploratory. Fungal infection was independently associated with severe stress (OR = 5.65, 95% CI 1.60–19.98), and concern about others noticing skin symptoms was independently associated with probable PTSD (OR = 1.24 per 1-point increase on a 5-point worry scale, 95% CI 1.00–1.52). 61% of participants reported concealing their skin condition from others; concealment was not significantly associated with any outcome. Dermatology patients during the Gaza conflict experienced an extremely high burden of psychiatric symptoms. Skin-disease-related factors, appearance-related concerns, and functional impairment were associated with worse psychiatric outcomes. Although these findings are based on a convenience sample of clinic attendees and a final sample below the pre-specified target, they highlight the potential value of integrated psychodermatology approaches—including mental health screening, stigma-sensitive counselling, and appropriate referral pathways—for further evaluation in conflict-affected humanitarian settings.