Background: Polycystic ovary syndrome (PCOS) is characterized by reproductive, androgenic and metabolic abnormalities, among which insulin resistance (IR) and acne are common. Hyperinsulinemia may theoretically exacerbate acne by increasing ovarian androgen production, suppressing sex hormone-binding globulin (SHBG), and modifying insulin-like growth factor signaling. Whether the magnitude of insulin resistance is independently associated with acne severity in women with PCOS remains uncertain. Objective: To systematically evaluate the association between insulin resistance and acne severity in women with PCOS and to quantitatively synthesize compatible measures of insulin resistance where possible. Methods: Seven primary studies involving 1,267 women with PCOS were included in the qualitative synthesis. Study sample sizes ranged from 60 to 318. Measures of insulin resistance included HOMA-IR, fasting insulin, QUICKI, fasting glucose and oral glucose tolerance testing. Acne was assessed by presence/absence, categorical clinical severity, Acne Global Severity Scale (AGSS), or acne scores. Random-effects inverse-variance meta-analysis was undertaken when at least two studies reported directly comparable data. Standardized mean differences were expressed as Hedges g, categorical associations as odds ratios (ORs), and continuous associations as correlation coefficients. Results: Evidence was inconsistent. Chen et al. reported HOMA-IR 2.7±4.4 among 123 women with acne versus 3.0±3.3 among 195 without acne. Schmidt et al. reported 3.55±4.80 (n=129) versus 4.21±9.28 (n=87), respectively (p=0.66). In an Indian cohort, 27/81 (33.3%) women had IR; severe acne occurred in 11/27 (40.7%) with IR versus 11/54 (20.4%) without IR, corresponding to a post-hoc severe-versus-nonsevere OR 2.69 (95% CI 0.98–7.41), although the original three-category severity comparison was not significant (p=0.146). In an Iranian cohort, HOMA-IR correlated negligibly with acne score (r=0.037, p=0.681). A 2025 Greek study found 2-hour glucose >140 mg/dL independently predicted mild/severe acne (OR 3.25, 95% CI 1.13–9.33; p=0.029). Two studies with compatible HOMA-IR data contributed 534 women to meta-analysis; pooled Hedges g was −0.09 (95% CI −0.26 to 0.09; p=0.334; I²=0%; τ²=0)