Metabolic Dysfunction and Acne Severity: Mechanisms and Clinical Implications

This review article examines the relationship between acne vulgaris and metabolic dysfunction, with a focus on insulin resistance, IGF-1 signaling, adiposity, dyslipidemia, and hyperandrogenic states. Although acne is traditionally considered a disorder of the pilosebaceous unit, emerging evidence suggests that systemic metabolic and endocrine factors may influence disease severity and persistence. This study provides a structured, domain-based synthesis of current literature, integrating clinical and mechanistic evidence without quantitative pooling due to heterogeneity across studies. The findings indicate that insulin resistance and IGF-1–mediated pathways are consistently associated with acne severity, while evidence linking acne to formal metabolic syndrome remains heterogeneous and less conclusive. The review highlights the importance of considering metabolic factors in selected patient populations, particularly those with severe, persistent, treatment-resistant, or hormonally influenced acne. It also emphasizes the need for targeted, risk-based clinical evaluation rather than universal metabolic screening. This work contributes to a more integrated understanding of acne as a condition influenced by systemic metabolic processes and provides a clinically relevant framework for dermatologists and researchers. Further longitudinal and interventional studies are needed to clarify causal relationships and inform management strategies.