Abstract

Insulin resistance (IR) has become increasingly recognized as having a systemic metabolic influence on acne despite having previously been viewed as only being influenced by four major factors. This systematic review aimed to summarize the findings on the relationship between IR and acne vulgaris based on all published data. A systematic literature search was performed according to the protocols outlined in the PRISMA 2020 guidelines. This review included observational studies (case-control, cross-sectional, and cohort) that compared the prevalence of insulin resistance between acne patients and healthy controls. After the review of literature, a total of nineteen studies representing various geographic populations were identified and included. The results of the studies showed that in every study, where acne prevalence rates were found to be higher in acne patients, with a range of 35% 81%. The severity of acne correlated positively with the level of insulin resistance measured primarily using Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). The previous consensus showed that hyperinsulinemia and increased androgenic drive (activity) are due to a combination of insulin resistance and acne pathogenesis, and that insulin resistance (IR) is related to factors such as decreased levels of i.e., adipokines (e.g., Irisin), and increased levels of a pro-inflammatory cytokine (e.g., TNF-alpha), etc. IR is associated with specific genetic polymorphisms (e.g., C4BPA) or different molecular profiles (e.g., cholesterol sulfate). Collectively, these findings supported the conclusion of a good and graded relationship between IR and acne vulgaris.

Key words: Acne vulgaris, insulin resistance, hyperinsulinemia, HOMA-IR, metabolic syndrome, systematic review.