Summary Background Ghrelin is a 28 amino acid peptide predominantly produced by the stomach. There are many putative roles for ghrelin beyond homeostatic appetite control. Aim of the work To determine ghrelin's level in postadolescent acne and study its relationship to plasma lipid profile, IR and acne severity and to correlate variables. Patients and methods This is a case‐control study where 50 patients with postadolescent acne and 50 age‐sex compatible controls were enrolled. Acne severity was assessed according to the Hayashi acne grading criteria. The parameters measured were serum level of ghrelin, fasting blood glucose, total cholesterol, low‐density lipoprotein, high‐density lipoprotein, triglycerides, and insulin. Results The mean serum level of Ghrelin was significantly lower in patients compared to control group and acne severity had a significant effect on ghrelin's level. Serum levels of insulin, fasting glucose, HOMA‐IR, and TG were significantly increased in patients group compared to control. Serum TC, HDL, and LDL showed no significant difference between both studied groups. Ghrelin hormone had a positive correlation to HDL and a negative correlation to BMI, LDL, HOMA‐IR, and Insulin. Conclusion This study postulated that low level of ghrelin may predispose patients with postadolescent acne to hyperinsulinemia, type 2 diabetes or dyslipidemia.