Background: Acne vulgaris is a common dermatological condition affecting adolescents and young adults worldwide. Recent evidence suggests a potential association between insulin resistance and acne pathogenesis. This study aimed to investigate the relationship between insulin resistance and acne vulgaris in the Indian population, where dietary patterns, genetic factors, and environmental influences may differ from previously studied populations. Methods: A cross-sectional study was conducted involving 240 subjects (120 acne patients and 120 age-matched controls) from three tertiary care centers in India. Acne severity was assessed using the Global Acne Grading System (GAGS). Anthropometric measurements, fasting blood glucose, fasting insulin levels, and homeostatic model assessment of insulin resistance (HOMA-IR) were evaluated. Dietary habits and lifestyle factors were assessed using validated questionnaires. Results: The prevalence of insulin resistance (HOMA-IR > 2.5) was significantly higher in acne patients compared to controls (42.5% vs. 18.3%, p < 0.001). Mean HOMA-IR values were significantly elevated in patients with acne compared to controls (2.84 ± 1.26 vs. 1.92 ± 0.88, p < 0.001). A positive correlation was observed between acne severity and HOMA-IR values (r = 0.64, p < 0.001). After adjusting for age, BMI, and family history, insulin resistance remained independently associated with acne vulgaris (OR = 2.86, 95% CI: 1.72-4.76). Conclusion: This study demonstrates a significant association between insulin resistance and acne vulgaris in the Indian population. The findings suggest that insulin resistance may contribute to acne pathogenesis and could represent a potential therapeutic target in its management, particularly in the context of the evolving dietary patterns in urban India.