Background: The pathogenesis of acne vulgaris(AV) is multifactorial. Insulin resistance has been implicated in the pathogenesis of AV in few recent studies. Strong evidence of the association of insulin resistance with AV patients is lacking in the Indian population. This study was done to evaluate insulin resistance in young patients with AV. Objectives: To assess the prevalence of insulin resistance in patients aged 14-25 years with AV and to compare it between AV patients and controls. Methodology: The study group was recruited from patients attending the Dermatology department at a General Hospital for a period of 18 months to study the insulin resistance using the HOMA-IR index in the age group 14-25 years with and without AV. In this prospective case-control study, 50 cases of acne vulgaris with 50 healthy age and sex-matched controls were included. Patients were counselled and informed consent was taken. In each case, detailed history, local and systemic examination was done. Acne grading for each patient was done based on the Global Acne Grading System (GAGS). Samples for fasting blood sugar and fasting serum insulin levels were taken. HOMA-IR index > 2 was arbitrarily taken as insulin resistance. Results: Mean HOMA-IR Index in cases was 2.21 ±0.88 whereas in controls it was 1.50 ±0.58 (p<0.05). The prevalence of insulin resistance was significantly higher in cases (56%) compared with controls (12%) (P = <0.001). The prevalence of insulin resistance did not differ significantly among the acne severity groups. Conclusions: Insulin resistance has to be considered as a major determinant in the pathogenesis of AV. The insulin resistance may be a phase of prediabetes and may develop diabetes mellitus in the future. The patients of AV should be followed up to find out about the development of the metabolic syndrome. Further large scale studies are required in this aspect to evaluate insulin resistance in AV patients. Interventional studies are required regarding target therapies directed towards insulin resistance in the treatment of AV.