Prevalence of Acne Vulgaris Among Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis.

Abstract

Background: Acne vulgaris is one of the most common dermatological conditions worldwide, particularly affecting women of reproductive age. It is often linked to underlying hormonal imbalances, including those seen in polycystic ovary syndrome (PCOS). PCOS is a prevalent endocrine disorder characterized by hyperandrogenism and insulin resistance, both of which contribute to acne vulgaris development. This systematic review and meta-analysis aimed to estimate the global prevalence of acne vulgaris among women with PCOS and identify contributing factors, thereby highlighting the burden of this skin condition in the context of a common endocrine disorder.

Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines, a systematic review of cross-sectional studies was conducted to assess the prevalence of acne vulgaris among women with PCOS. The literature search included studies published up to January 2025 and was performed in 5 major databases: PubMed, EMBASE, Scopus, Web of Science, and Google Scholar. Study selection was guided by the POLIS framework, focusing on women diagnosed with PCOS based on established criteria (Rotterdam, National Institute of Health [NIH], or Androgen Excess Society [AES]). Only cross-sectional studies reporting the prevalence of acne vulgaris in this population were included. A random-effects (REM) meta-analysis was performed using data from 95 eligible studies. Subgroup analyses were conducted based on geographical region, age, body mass index (BMI), PCOS diagnostic criteria, and acne vulgaris severity to explore sources of heterogeneity.

Results: As per the findings, acne vulgaris, the pooled prevalence of which was 49% (95% CI: 47%-52%), determined 95 studies, with high heterogeneity (I² = 98.86%, P = 0.04) and evidence of publication bias (P < 0.001), remained the most frequent comorbidity in women with PCOS. However, after trim and fill adjustment, the prevalence fell to 37% (95% CI: 35%-39%). The subgroup analyses also revealed the prevalence of the highest in Oceania (76%, 95% CI: 69%-83%), whereas the prevalence of adolescents <18 years was 66%, 95% CI: 49%-81%, and less in Europe (32%, 95% CI: 28%-36%) and women >30 years (42%, 95% CI: 38%-46%), respectively. The rate was somewhat higher among women with a BMI ≤25 kg/m² (53%) in comparison with those with a BMI of >25 kg/m² (48%). Mild acne vulgaris scored the most (40%, 95% CI: 27%-53%) among the research participants.

Conclusion: The prevalence of acne vulgaris among women with PCOS varies widely across studies, with subgroup analyses revealing a range influenced by factors such as region, age group, and diagnostic criteria. These findings highlight the need for standardized diagnostic tools for PCOS and comprehensive management approaches that address hormonal, metabolic, and psychological aspects to improve outcomes for affected women.