People using GLP-1 drugs to manage their weight may be more likely to develop acne, according to a recent report.

In a retrospective study, researchers analyzed the number of acne vulgaris diagnoses among people with obesity but not diabetes who had been prescribed Saxenda (liraglutide), Wegovy (semaglutide), or Zepbound (tirzepatide).

The researchers matched more than 162,000 GLP-1 drug users—three-quarters of whom were women—with people who were not taking the medications. Those on GLP-1s were 34% more likely to be diagnosed with acne within a year.

The effect was most obvious in women. They were 53% more likely to develop acne than men. Men who used a GLP-1 drug were no more likely to get an acne diagnosis than those who did not.

Acne was not a reported side effect in the major GLP-1 clinical trials, said Stan Tolkachjov, MD, senior author of the study and a double board-certified dermatologist in Texas.

However, Tolkachjov and his team noticed social media posts and increased reports from other dermatologists saying that their patients experienced more breakouts after they started taking the medications.

A 2024 survey found that 12% of people in the U.S. have taken a GLP-1 medication to treat obesity. More robust studies are needed to determine whether the GLP-1 medications are really causing acne in women and what might be causing it if so.

“Most patients, especially those who are getting treated for weight, want to look and feel better. They probably don’t want to also have acne that can scar them,” Tolkachjov said.

Making Sense of the Surprising Side Effect

The findings, Tolkachjov said, are surprising.

Hormonal imbalances are often the culprit of acne. An increase in testosterone can cause the skin to produce more sebum, an oily substance that can clog pores and cause acne.

Men with obesity or overweight tend to have lower levels of testosterone than those of a healthy weight. As they lose weight, their testosterone levels increase. Meanwhile, women with obesity who lose weight tend to see reductions in their testosterone levels.

“Typically, when you lose weight, you have better hormonal levels. Women have less testosterone and should potentially have less acne, but that’s not what we saw here,” Tolkachjov said.

“There’s a bit of an emotional factor when you see data that doesn’t seem to make sense,” Tolkachjov said. “It’s a very complex finding, and going forward, we’re going to need bigger data sets.”

Weight loss can often help improve acne in people with certain health conditions, such as hidradenitis suppurativa and polycystic ovary syndrome (PCOS). People with PCOS tend to have higher levels of testosterone and other androgen hormones. Insulin resistance, which is also common in PCOS, is also related to a higher likelihood of acne flare-ups.

GLP-1 drugs can support better glycemic control and improve insulin sensitivity, which should help reduce breakouts, said Anthony Rossi, MD, a board-certified dermatologist and dermatologic surgeon at Memorial Sloan Kettering Cancer Center.

“These GLP-1s are improving their insulin sensitivity, they’re improving their metabolic syndrome, and they’re usually decreasing inflammation, which is also sometimes a driver of acne,” Rossi said.

He said it’s possible that acne flare-ups could be related to the short-term fluctuation in hormones, insulin sensitivity, and other factors as the body gets accustomed to the medications. Sometimes, crash dieting and rapid weight loss can lead to acne and other dermatologic health problems due to hormonal imbalances.

What Else Could Contribute to Acne in GLP-1 Users?

It’s unlikely, Rossi said, that the medication itself is causing acne flare-ups. If so, the effect would likely be apparent in both sexes.

People who take a GLP-1 medication also tend to have elevated levels of insulin-like growth factor 1 (IGF-1), a growth hormone that helps control sebum production.

Early studies have linked elevated levels of IGF-1 to acne in women. The authors suggested that the sex difference in their study could be related to the sex difference seen in studies linking acne to IGF-1.

It’s also possible that the study didn’t perfectly capture the relationship between the drugs and acne. An earlier meta-analysis of 45 studies found no relationship between the use of six different GLP-1 drugs and acne cases.

“Because acne is so cyclical in nature, and this is a retrospective design, there’s a little bit of a confounding variable. It really is time-dependent on when they started the drug, and sometimes it’s hard to control for that in a retrospective design,” Rossi said.

The average age of women in the new study’s dataset was 47. This means many participants were likely going through the menopause transition, a life period marked by significant hormonal shifts.

This study didn’t tease out differences in acne development between women of different ages—future studies will have to investigate that.

To establish a relationship between GLP-1 drug use and acne, researchers will need to conduct a prospective trial that compares acne outcomes between a group that takes the medication and a control group that does not.

What to Do About Breakouts While Taking GLP-1

Rossi said that if he had a patient present with acne while taking a GLP-1 drug, he would take a “deeper dive” into their hormone profile to see if there are any obvious imbalances.

He explained that medications like oral contraceptives could help balance hormones.

A few of the most effective medications for treating acne are systemic medications that can interact with certain other medications. Those include isotretinoin (Accutane) and spironolactone—a blood pressure medication commonly used off-label to treat acne.

Tolkachjov said his team looked at the scientific literature for any mention of issues for people who take both a GLP-1 medication and a systemic acne drug. They’ve found no such reports so far.

“If patients are getting really inflammatory acne or cystic or scarring acne, we need to get them on systemic therapies very quickly,” Tolkachjov said.

“What is safe in this setting? A lot of these patients are not going to want to get off the GLP-1s. They’re getting the weight loss or effect that they desire. We’re not telling them necessarily to stop,” he added. “We just want to make sure that their acne and everything else is under control.”