Glucagon-like peptide-1 (GLP-1) receptor agonists, including semaglutide and liraglutide, are increasingly prescribed for type 2 diabetes and weight management in the UK. Whilst these medications have well-established metabolic benefits, some patients have questioned whether GLP-1 treatment might influence skin conditions such as acne vulgaris. Currently, no large-scale clinical trials have directly examined the relationship between GLP-1 agonists and acne, and these medications are not licensed for dermatological indications. However, the metabolic improvements and weight loss associated with GLP-1 therapy may indirectly affect hormonal factors that influence acne severity. This article examines the available evidence and explores potential mechanisms linking GLP-1 treatment to skin health.

What Are GLP-1 Medications and How Do They Work?

Glucagon-like peptide-1 (GLP-1) receptor agonists are a class of medications originally developed for managing type 2 diabetes mellitus, though some are now also licensed for weight management in adults with obesity. These medicines include semaglutide (marketed as Ozempic for diabetes and Wegovy for weight management), liraglutide (Victoza for diabetes and Saxenda for weight management), dulaglutide (Trulicity, for diabetes only), and tirzepatide (Mounjaro for diabetes, Zepbound for weight management), which combines GLP-1 action with glucose-dependent insulinotropic polypeptide (GIP) receptor agonism.

GLP-1 is a naturally occurring incretin hormone released by the intestine in response to food intake. GLP-1 receptor agonists work by mimicking this hormone's effects on multiple organ systems. Their primary mechanisms of action include:

• Enhancing insulin secretion from pancreatic beta cells in a glucose-dependent manner, which generally reduces the risk of hypoglycaemia (though this risk increases when combined with insulin or sulfonylureas)

• Suppressing glucagon release from pancreatic alpha cells, thereby reducing hepatic glucose production

• Slowing gastric emptying, which prolongs satiety and reduces postprandial glucose excursions

• Acting on appetite centres in the hypothalamus to reduce hunger and food intake

These combined effects lead to improved glycaemic control in people with type 2 diabetes and significant weight reduction in those prescribed these medications for obesity management. NICE has provided specific guidance on their use within the NHS based on eligibility criteria, including body mass index thresholds and the presence of weight-related comorbidities.

Whilst GLP-1 medications have well-established benefits for metabolic health, patients and clinicians have begun questioning whether these drugs might influence other conditions, including dermatological concerns such as acne vulgaris. It is important to note that these medications are not licensed for the treatment of acne.

The Link Between GLP-1 Agonists and Skin Health

There is currently no official, direct link established between GLP-1 receptor agonists and acne improvement based on large-scale clinical trials or regulatory guidance. The primary clinical trials evaluating GLP-1 medications, such as the STEP trials for semaglutide and SUSTAIN programme, focused on glycaemic control, cardiovascular outcomes, and weight loss—not dermatological endpoints. Acne was not systematically assessed or reported as an outcome measure in these pivotal studies, and it is not listed as either an indication or a common adverse reaction in UK product licences.

However, emerging anecdotal reports and smaller observational studies have prompted interest in potential indirect effects on skin health. Some patients taking GLP-1 agonists have reported subjective improvements in acne, whilst others have noted no change or, occasionally, worsening of skin conditions. It is important to emphasise that individual experiences vary considerably, and such reports do not constitute clinical evidence of causation.

The theoretical basis for any potential skin effects relates to GLP-1's broader metabolic actions rather than direct dermatological mechanisms. GLP-1 receptors are expressed in various tissues beyond the pancreas and brain, including some immune cells, though their presence and functional significance in skin tissue remains poorly characterised. No pharmacological evidence currently supports a direct anti-inflammatory or sebum-regulating effect of GLP-1 agonists on the pilosebaceous unit—the primary site of acne pathology.

Patients considering or taking GLP-1 medications should understand that whilst these drugs offer proven benefits for diabetes and weight management, any effects on acne are likely indirect and related to the metabolic and hormonal changes that accompany weight loss and improved insulin sensitivity, rather than a specific therapeutic action on acne itself.

How Weight Loss and Metabolic Changes May Affect Acne

The most plausible explanation for any observed changes in acne among people taking GLP-1 agonists relates to weight loss and improvements in metabolic health rather than direct drug effects. Obesity and insulin resistance are associated with hormonal imbalances that can influence acne severity, particularly in adults.

Insulin resistance and hyperinsulinaemia stimulate the production of androgens (male hormones present in both sexes) and reduce levels of sex hormone-binding globulin (SHBG). This results in higher levels of free, biologically active androgens, which can:

• Increase sebum production by sebaceous glands

• Promote follicular hyperkeratinisation (abnormal skin cell turnover)

• Contribute to the inflammatory processes underlying acne lesions

When GLP-1 medications facilitate significant weight loss and improve insulin sensitivity, these hormonal disturbances may partially normalise. Reduced insulin levels can lead to decreased androgen production and increased SHBG, potentially reducing sebum production and acne severity in susceptible individuals. This mechanism is particularly relevant for people with polycystic ovary syndrome (PCOS), a condition characterised by insulin resistance, hyperandrogenism, and often troublesome acne.

Additionally, weight loss may reduce systemic inflammation, as adipose tissue—especially visceral fat—produces pro-inflammatory cytokines. Lower inflammatory burden might theoretically benefit inflammatory skin conditions, though the magnitude of this effect on acne specifically remains uncertain.

It is crucial to note that these potential benefits are indirect consequences of metabolic improvement rather than specific pharmacological actions of GLP-1 agonists. Similar improvements might be observed with weight loss achieved through other means, including lifestyle modification, bariatric surgery, or alternative weight-loss medications. The timeline for any such changes would typically follow substantial weight reduction, which may take several months of GLP-1 treatment.

Other Factors That Influence Acne While Taking GLP-1

When considering changes in acne during GLP-1 treatment, it is essential to account for multiple confounding factors that may influence skin health independently of the medication itself.

Dietary changes often accompany GLP-1 therapy, both as a result of reduced appetite and as part of comprehensive weight management programmes. Some dietary patterns—particularly those high in refined carbohydrates and dairy products—have been associated with acne in observational studies, though evidence remains inconsistent. Patients who adopt healthier eating patterns whilst taking GLP-1 medications may experience skin changes related to diet rather than the drug directly.

Common adverse effects of GLP-1 agonists may indirectly affect skin health. Gastrointestinal symptoms such as nausea, vomiting, and diarrhoea—reported by a significant proportion of patients, particularly during dose escalation—can lead to dehydration and nutritional changes. Adequate hydration and nutrition are important for skin health, and deficiencies might theoretically worsen skin conditions. If you experience persistent gastrointestinal symptoms, seek advice from your healthcare provider.

Hormonal fluctuations during weight loss can be complex and variable. Whilst improved insulin sensitivity generally has favourable hormonal effects, rapid weight loss can temporarily disrupt hormone levels, including sex hormones and cortisol. These fluctuations might cause unpredictable changes in acne, with some individuals experiencing temporary worsening before improvement.

Concurrent medications and skincare routines must also be considered. Patients taking GLP-1 agonists for diabetes may be on other medications (such as metformin) that can affect skin health. Changes in skincare products, cosmetics, or topical treatments during the same period could influence acne independently.

Finally, stress, sleep patterns, and overall lifestyle changes associated with embarking on a weight management programme may affect acne through well-established psychoneuroimmunological pathways. Attributing skin changes solely to GLP-1 medication without considering these multiple variables would be an oversimplification.

If you suspect an adverse reaction to any medication, you can report this through the MHRA Yellow Card scheme.

When to Speak with Your GP About Acne and GLP-1 Treatment

If you are taking or considering GLP-1 medication and have concerns about acne, open communication with your GP or prescribing clinician is essential. Whilst GLP-1 agonists are not prescribed specifically for acne treatment, your healthcare provider can help you understand potential indirect effects and manage any skin concerns appropriately.

You should contact your GP if you experience:

• New or worsening acne after starting GLP-1 treatment, particularly if it is severe, painful, or affecting your quality of life

• Signs of skin infection, such as increasing redness, warmth, swelling, or pustular lesions that may indicate secondary bacterial infection

• Scarring or post-inflammatory hyperpigmentation that concerns you

• Psychological distress related to skin changes, as acne can significantly impact mental wellbeing

Your GP can assess whether your acne requires specific dermatological treatment, which may include topical therapies (such as benzoyl peroxide, topical retinoids, or topical antibiotics), oral medications (including oral antibiotics or, in appropriate cases, hormonal treatments), or referral to dermatology services for more complex cases.

Referral to a dermatologist may be considered if you have severe nodulocystic acne, acne at risk of permanent scarring, acne that has not responded to adequate courses of standard treatments, or acne causing significant psychological distress.

If your acne occurs alongside other symptoms such as menstrual irregularity or excess facial/body hair, your GP may also consider assessment for hormonal conditions like polycystic ovary syndrome (PCOS).

For severe acne, specialists may consider oral isotretinoin, which is only prescribed by or under the supervision of consultant dermatologists. This medication is highly teratogenic (can cause birth defects) and requires participation in the MHRA Pregnancy Prevention Programme for women of childbearing potential, along with regular monitoring of blood tests.

Do not discontinue GLP-1 medication without medical advice if you experience skin changes. The proven benefits of these medications for diabetes control and weight management typically outweigh concerns about acne, which can usually be managed with appropriate dermatological treatment. Your healthcare team can help you weigh the benefits and risks and develop a comprehensive management plan that addresses both your metabolic health and skin concerns.

Frequently Asked Questions