INSULIN RESISTANCE AND ITS ASSOCIATION WITH ACNE SEVERITY IN WOMEN WITH PCOS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: A Naga Pravalika, D. Sravani, Mallu Srinija
Publication Date: 2026/09/24
DOI: 10.59551/10.59551/IJHMP/25832069/2026.7.2.164
Abstract
<p><strong>Background</strong>: Acne is a common dermatological manifestation of polycystic ovary syndrome (PCOS). Although hyperandrogenism is a well-established driver, insulin resistance (IR) and compensatory hyperinsulinemia may amplify sebaceous activity, androgen bioavailability, inflammatory signaling, and follicular keratinization. The extent to which IR is associated with acne severity specifically in women with PCOS remains uncertain.</p>
<p><strong>Objective</strong>: To systematically evaluate the relationship between insulin resistance and acne severity in women with PCOS and to synthesize evidence relating HOMA-IR, fasting insulin, fasting glucose, oral glucose tolerance, QUICKI, and androgenic-metabolic variables to acne severity.</p>
<p><strong>Methods</strong>: A PRISMA 2020-aligned systematic review framework was used. MEDLINE/PubMed, Embase, Scopus, Web of Science, and Google Scholar were considered for studies evaluating women with PCOS in whom acne and at least one insulin-resistance or glucose-metabolism measure were assessed. The search identified 623 records. After removal of 172 duplicates, 451 records were screened, 386 were excluded, 65 reports were sought, 4 were not retrieved, and 61 full-text reports were assessed. Fifty-five reports were excluded, leaving 6 directly relevant primary studies for systematic synthesis; 4 had sufficiently compatible numerical data for a limited quantitative synthesis.</p>
<p><strong>Results</strong>: Across the included studies, acne prevalence among women with PCOS ranged from approximately 54% to 61% in clinically characterized cohorts. The largest contemporary study included 305 women with PCOS and found acne in 56.4%; abnormal 2-hour glucose was independently associated with greater acne severity (OR 3.25, p=0.029), together with younger age and higher DHEAS. A 110-woman PCOS cohort demonstrated associations between acne severity and glucose-androgenic abnormalities, but HOMA-IR was not uniformly related to grade. In a North Indian cohort of 81 women with both acne and PCOS, 33.3% met the study definition of insulin resistance. A 2024 case-control study of women with moderate and severe acne plus PCOS found HOMA-IR elevated compared with controls, while moderate and severe acne groups themselves showed similar HOMA-IR values. Taken together, the direction of effect favored greater metabolic dysfunction among women with acne, but the relationship between HOMA-IR and lesion severity was inconsistent.</p>
References
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