Background: Acne vulgaris is a chronic inflammatory skin disorder affecting approximately 85% of adolescents and young adults and represents more than just a cosmetic concern. While often perceived as a superficial condition, it is associated with various systemic diseases and comorbidities, including hormonal imbalances and metabolic syndromes. This study aims to explore the associated diseases and possible comorbidities in acne vulgaris patients. Methods: A cross-sectional study was conducted on 100 female patients diagnosed with acne vulgaris at the Dermatology Department of Travancore Medicity Medical College. Acne severity was assessed using the GAGS(Global Acne Grading System). Data on demographics, clinical features, and hormonal profiles were collected.Insulin resistance was evaluated using the HOMA-IR (Homeostatic Model Assessment of Insulin Resistance). Data analysis was performed using SPSS version 26.0, with statistical significance set at p<0.05. Results: The study found that 53% of patients were under 20 years old, with Grade III acne being the most common (30%). Seborrhea (75%), acanthosis nigricans (72%), alopecia (69%), hirsutism (68%), and menstrual irregularities (65%) were the most prevalent comorbidities. Insulin resistance was observed in 63% of patients, and elevated LH:FSH ratios (>2) were noted in 54%. Conclusion: This study underscores the complex interplay between acne vulgaris and systemic metabolic-hormonal disturbances, particularly insulin resistance and hyperandrogenism. The high prevalence of associated conditions suggests that acne vulgaris might serve as an early cutaneous marker for underlying metabolic syndrome or polycystic ovary syndrome. Early identification of these associations may facilitate timely intervention and potentially prevent the development of more serious metabolic complications.