Metformin - a novel agent for acne

Acne is a common inflammatory disorder that affects children and adults. Even though it can be controlled with antibiotics and isotretinoin, there is a group of patents who are resistant to single agents. Metformin, an anti-diabetic medication, may be helpful in the treatment of acne. Previous studies have confirmed its effectiveness in acne when there is underlying polycystic ovarian syndrome, diabetes or obesity. In this study, the authors have found that even those with normal weight and without underlying polycystic ovarian syndrome or diabetes may benefit from this drug.
Metformin as an adjunct therapy for the treatment of moderate to severe acne vulgaris: A randomized open-labeled study. Suganthy Robinson, Zhenli Kwan, Min Moon Tang. Dermatologic Therapy. 2019;32:e12953.
doi.org/10.111...
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[@robertbach9085]

Useful information, thank you!

[@DiscoverDermatology]

Thank you!

[@RohanYesudian]

Metformin is one of those 'wonder drugs'. It's also been associated with anti-aging and anti-cancer effects

[@DiscoverDermatology]

Thanks Ro! Agree that metformin is a wonderful drug and its anti-ageing and anti-cancer effects are impressive too.

[@julianofaria1492]

Interesting, but is it possible to remove metformin in the future once the acne improves? My fear is that by dropping MET, Insulin resistance may get worse in comparison to the pre treatment. I don't know if this can happen, though.

[@DiscoverDermatology]

Metformin has been studied only for courses of 4 months so it is certainly possible to stop the medication after 4 to 6 months. In the long term, the best option would be to use exercise and diet to control our skin conditions. Here is a video on that topic.
th-cam.com/video/CB2D3NUTzDI/w-d-xo.html

[@hudsonboycandleco.8317]

Helpful video! Thank you! Can berberine have the same effects on acne? Any suggestions for chronic oily facial skin?

[@DiscoverDermatology]

Good point. I have looked in the literature and there are some studies that suggest berberine to be helpful in acne. I think more robust evidence is needed though.
There is good evidence that there is a relationship between the gut microbiome and acne. I plan to do a video on it in the future.
For oily skin, Vitamin A may be an option, here is a video that I have done on it.
th-cam.com/video/eJCtszwBx9M/w-d-xo.html

[@hudsonboycandleco.8317]

@@DiscoverDermatology Thank you!

[@krishnakumarsubramanian1253]

very useful Dr

[@DiscoverDermatology]

Thanks KK!

[@dulidp1]

Very interesting

[@DiscoverDermatology]

Thanks Duli!

[@DanielleK.Bayoro]

I have suffered with nodular and cystic acne since my teen years. I am now in my late 30s still suffering from the painful breakouts. I have not been diagnosed with PCOS, I have been diagnosed with B12 deficiency, which I am currently taking daily supplements for. The only treatment that has cleared my acne is OCPs, but I recently stopped because I have been noticing frequent migraines, and also I am aiming for pregnancy. I had to stop taking cyclines because of the side effects, and I also do not qualify for spironolactone, vitamin A or isotretenoin because of the teratogenic effects. I’m not overweight (BMI is 29), and I’m not attempting to lose weight, as I look smaller in person than on paper. Would you recommend metformin for treatment of hormonal acne in such a case?

[@DiscoverDermatology]

Metformin is certainly an option if other medications have been excluded or are ineffective. It tends to work in combination with other agents, so topical antibiotics could be used in conjunction. Life style factors like diet are also important. Here is a video on it
th-cam.com/video/mlibruVkxmQ/w-d-xo.html

[@ankitaghosh3468]

I was on metformin. I am non diabetic and I don't have PCOS. It cleared my skin amazingly. But I suffered quite bad gastrointestinal side effects while on metformin, including nausea, loss of appetite, and weight loss. Once I stopped metformin the acne returned back as usual. I am a chronic acne sufferer. Previously, I had been on isotretinoin, and finasteride. All of them worked very well. Cleared my acne and improved my skin dramatically. But once I stopped taking them (as per my dermatologist's advice), the acne always returned back. These medications, including metformin work only when we take them, they have absolutely no long term efficacy. After discontinuing, they have no effectiveness, and we are back to where we were. This is utterly disappointing. We can't take these medicines all our life. If their effect is so temporary, then what good are they for? I humbly request medical practitioners and researchers to look into this aspect. Your cure is just temporary. Our suffering is perpetual. I noticed you take the pain to reply to comments. Hoping to receive some insight from you on my query. Thank you Doc.

[@DiscoverDermatology]

You are right, it is disappointment that we are still unable to "cure" many skin conditions. If acne is persistent, I guess hormonal factors may be perpetuating it. However, some people just have pores that get blocked more easily, so whatever we use, even isotretinoin, it tends to recur. Unfortunately medical science does not have any answer to all problems, but we can try to control it, which is better than having no treatment. Another option you have not mentioned is Spironolactone. Here is a video on it.
th-cam.com/video/04D24LKdp5U/w-d-xo.html
If you would like to try alternative milder treatment, Montelukast is a possibility, here is a video
th-cam.com/video/wyRkC9Ahv_U/w-d-xo.html

[@ankitaghosh3468]

@@DiscoverDermatology Thank you so much for your reply.
I mentioned the drugs which I had taken. I was never prescribed spironolactone. But yes I am aware of its use in acne and the effect is perhaps temporary, similar to the other drugs. Thanks for acknowledging the limitations. Hopeful of advancements in future acne medications. A recent discovery, a topical anti androgen, clascoterone is raising my spirits. However, it's probably not yet available in my country. Hope to see a video on this soon!

[@DiscoverDermatology]

Yes, there are quite a few new treatments in the horizon. I try and focus on the medications that have scientific proof of efficacy. Another natural treatment option is to use Vitamin A in high doses, which
mimics Isotretinoin. Here is a video on it
th-cam.com/video/eJCtszwBx9M/w-d-xo.html
@@ankitaghosh3468

[@samjaipal]

I think scientist have already found out the solution but Parma companies have paid the scientist not to publish medication otherwise how the Parma and cosmetic companies will make money by selling the acne products .

[@samjaipal]

@@DiscoverDermatology I think scientist have already found out the solution but Parma companies have paid the scientist not to publish medication otherwise how the Parma and cosmetic companies will make money by selling the acne products .

[@colepillay7674]

Good day , I do have acne although i am 23yrs old now . Could I start taking metformin and what are the precautions and how to prescribe it?

[@DiscoverDermatology]

Metformin can be used in any age. It does not act on its own though. It needs too be combined with the usual ant-acne treatment that can be prescribed by a dermatologist. The usual precautions are to start low and then work up the dose as mentioned in the video. Serious side effects are unusual.

[@cristalhall1663]

Would you recommend metformin in pcos acne for someone with low normal fasting glucose? They are no longer able to use oral contraceptives though this helped acne…and little improvement in skin with doxycycline and benzoyl peroxide?

[@DiscoverDermatology]

The study reviewed in the video suggests that metformin helps even in those who do not have raised glucose levels.
Spironolactone may be an option if other treatments have not been helpful. Here is a video on it
th-cam.com/video/04D24LKdp5U/w-d-xo.html
Low dose Isotretinoin is a treatment that we use frequently. However, if this is difficult to access, oral Vitamin A is a natural option. Here is a video on it
th-cam.com/video/eJCtszwBx9M/w-d-xo.html

[@marvbord]

Can adult men use this for acne?

[@DiscoverDermatology]

Metformin can be used for both men and women for acne. Diet and intermittent fasting may also help, Here are a couple of videos on these factors
th-cam.com/video/Amu_x21y19I/w-d-xo.html
th-cam.com/video/mlibruVkxmQ/w-d-xo.html

[@roopa9704]

Can we have metformin and isotretinoin on same time ?

[@DiscoverDermatology]

Yes, it’s a useful combination and together it may work better than just one of the mediations on its own.

[@roopa9704]

@@DiscoverDermatology thank you doctor

[@varsha6318]

I have persistent acanthosis nigricans, mild pcos and I'm at a normal weight (enough where i can't lose any more). Can I take metformin to help acanthosis nigricans?

[@DiscoverDermatology]

Yes, metformin seems to be helpful in acanthosis nigricans too, even if the body weight is normal.

[@reginaphalange5915]

Sir can metformin be used if already taking isotretinoin ?

[@DiscoverDermatology]

Yes, my practice is to use metformin with other anti-acne medications like isotretinoin. I doubt if metformin will clear the skin completely on its own.

[@ZedEdo-t5p]

What happen of non diabyoc take Metformin?

[@DiscoverDermatology]

There are no major side effects with metformin in those who do not have diabetes as far as previous studies have shown.

[@agscolony]

Whether Metfomin is contraindicated in non diabetics Diva?

[@DiscoverDermatology]

Excellent question. Yes mama, it can be used for non-diabetics too for acne. It does not lower blood sugar and actually facilitates weight loss, which is beneficial.

[@dipikakc2172]

Can metformin be used even if the patient doesnt have any underlying cause that is diabeties and pcos ? Bt is suffering from acne ?

[@DiscoverDermatology]

Yes, that is what the study has shown. Even those without diabetes or PCOS seem have benefitted form metformin