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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.
Fabbrocini G et al. Low glycaemic diet and metformin therapy: A new approach in male subjects with acne resistant to common treatments. Clin Exp Dermatol 2015 Jun 6; [e-pub]. (http://dx.doi.org/10.1111/ced.12673)
Comment
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.