Metformin: A New Approach to Acne Therapy?

Summary and Comment |
July 24, 2015

Metformin: A New Approach to Acne Therapy?

  1. Mark V. Dahl, MD

The use of metformin and a hypocaloric diet significantly improved stubborn acne in young men with an altered metabolic profile.

  1. Mark V. Dahl, MD

Women with polycystic ovaries and insulin resistance frequently develop acne. Insulin-like growth factor stimulates production of androgens and the growth of sebaceous glands. Does insulin resistance predispose to acne in men? Would treatment with a hypoglycemic diet and metformin reduce acne in men with an altered metabolic profile?

Investigators studied a group of 20 young men (mean age, 19.5) with acne resistant to common therapies and an altered metabolic profile as defined by elevated fasting glucose level, raised levels of total low-density lipoprotein, low levels of high-density lipoprotein, and waist circumference and body-mass index at the upper limit of normal. Half the group was randomly assigned to receive metformin (500 mg twice daily; group A) and consume a hypocaloric diet low in carbohydrates and rich in fruits, vegetables, and fish. The other half continued their regular diets without metformin (group B). All subjects used a bland detergent to wash and applied an antiacne cream containing azelaic acid and nicotinamide.

After 6 months, mean Global Acne Grading System (GAGS) scores were reduced significantly in the metformin group (from 25.1 to 14.1; P<0.03) and nonsignificantly in the nonmetformin group (from 24.9 to 19.4; P=0.06). Oral glucose serum levels were also reduced significantly in the metformin group (P<0.04). No metformin-related adverse effects were reported.


This small study showed a trend for better outcomes with metformin and a hypocaloric diet for group A. A larger study may show significance. Both groups were treated with standard antiacne therapies that may obscure the true response to metformin and low-caloric diet alone. The hypothesis does make sense. Metabolic syndrome and insulin resistance may well be associated with stubborn acne in men. Metformin decreases hepatic glucose output and increases utilization of glucose by muscle cells and adipocytes, thereby reducing serum insulin levels and effects. A low-caloric, low-carbohydrate diet may also help.

Editor Disclosures at Time of Publication

  • Disclosures for Mark V. Dahl, MD at time of publication Consultant / Advisory board Ulthera, Inc.; AuBio LifeSciences, LLC; Paris Therapeutics Equity Elorac, Inc.; Makucell, Inc.; Paris Therapeutics Editorial boards UpToDate Leadership positions in professional societies National Rosacea Society (Chairman, Medical Board)


Reader Comments (3)

Victor Kantariya Physician, Family Medicine/General Practice

Is Metformin safe in Heart Failure? Mild HF is unlikely to be associated with hypoxemia, lactic acidosis ,and therefore is not a contraindication to the use of metformin. In contrast, intensive glycemic control significantly increased HFrisk. Optimal survival was seen among patients with advanced HFwith"modest" control (HbA1C of 7,1%to 7,8%),a rule the lower the better is a wrong way. Priority should be given to the individual treatment, not to guidelines.

Sobhya Bhutto(MBBS) Resident, Internal Medicine

Is metformin associated with any cardiac malfunction like cardiomyopathy with protracted use? My aunt used to take it for her Diabetes.. She developed CMP after 3 or 5 yrs of use and it was progressive enough to pull her cardiac function down from 35% to 15 % in 6 months.. N she died of heart failure.. I hv also read some studies supporting this fact.. What will u say abt it?

Obioma Ekpe MD Resident, Dermatology, Federal Medical Centre Umuahia

Very Educating. It will improve my Management of Acne in Obesed individuals and patients with signs of polycystic Ovarian syndrome.

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