Obesity: A Modulator in Acne Management

Abstract

Acne vulgaris is an inflammatory and multifactorial skin disease involving the sebaceous gland and the skin microbiome. Different exposome factors, including hormonal and family factors, have been suggested to influence acne. Obesity is an increasingly observed condition worldwide, and is considered as a public health problem by the World Health Organization. Recently, a high body mass index has been identified as an acne severity risk factor in adolescents. A group of 5 dermatologists from different institutions and private practices from France involved in the research and clinical fields of acne -analysed recent literature on "obesity and acne" focusing on epidemiology, the pathogenesis of acne and obesity, as well as the management of acne in obese patients. The authors selected, prior to their discussion in November and December 2024 and again in March 2025, and discussed 52 articles concerning acne and obesity published since 2000 and available from the PubMed database. The authors agreed that, considering these common metabolic features, managing both acne and obesity in parallel and helping patients through a global approach including dermatological, endocrinal, psychological and nutrition, as well as lifestyle support is mandatory, and may allow for the improvement of both acne and obesity. Moreover, in order to allow dermatologists to manage acne in obese patients in the most efficient way, the authors developed and propose a decision tree. The authors consider that acne in obese patients is not a fatality, and taking care of acne should not be considered an isolated task in this specific patient population.

Fig. 1

Shared physiopathology between acne and obesity. IGF1: insulin-like growth factor 1; mTORC1: mammalian target of rapamycin complex 1; SREBP: sterol regulatory element-binding protein; PPAR: peroxisome proliferator-activated receptor.

Fig. 2

Proposed treatment pathway for obese patients consulting for acne. All treatment decisions should include adjuvant adapted skin care including the use of specific cleansers and moisturizing creams. Moreover, patients should be advised to avoid exfoliation, masks, scrubs, and essential oils.