BackgroundAcne is a common, multifactorial skin condition with significant psychosocial and public health impacts. However, its burden among reproductive-age women remains underexplored.MethodsUsing Global Burden of Disease (GBD) 2021 data, we analyzed acne incidence, prevalence, and disability-adjusted life years (DALYs) in females aged 15-49 across 204 countries (1990-2021). Trends were assessed via age-standardized rates and estimated annual percentage change (EAPC). Decomposition and inequality analyses identified contributing factors. Bayesian age-period-cohort (BAPC) modeling projected trends to 2040.ResultsFrom 1990 to 2021, acne incidence, prevalence, and DALYs rose by 34%, 38%, and 37%, respectively. The greatest increases occurred in low-socio-demographic index (SDI) regions (e.g., Sub-Saharan Africa). The 15-19 age group had the highest burden, but older age groups showed faster growth. Population growth was the key driver. Inequalities narrowed overall but remained complex. Projections show continued burden growth by 2040.ConclusionsThe acne burden among reproductive-age women is increasing globally, especially in low-SDI regions and adolescents, underscoring the need for targeted strategies.