Background: Acne vulgaris is a common skin disease in adolescents known to be associated with oxidative stress. However, the number of studies in which oxidative stress and antioxidants are evaluated together is limited. Aims: In this study, we aimed to investigate L-arginine/nitric oxide (NO) pathway metabolites, ischemia-modified albumin (IMA), and vitamin A and E levels in patients with acne and its association with disease severity. Patients/Methods: Ninety patients with acne and 30 healthy adults were included in the study. The serum levels ofL-arjinin, L-arginine metabolites, IMA, and vitamins A and E measured in the patient and control groups. Results: Asymmetric dimethylarginine (ADMA), LNG-monomethyl-L-arginine (L-NMMA) and symmetric dimethylarginine (SDMA), and IMA levels were significantly higher in the patients with acne than in the control group (P ˂.05). The L-arginine/ADMA ratio and citrulline and vitamin A levels were significantly lower in patients with acne than those of the controls (P ˂.05). ADMA and IMA plasma levels were increased in parallel with the disease severity (P ˂.05). L-arginine/ADMA ratio, L-arginine, citrulline, and vitamin A plasma levels decreased as the disease became severe (P ˂.05). Although L-arginine and vitamin E levels were lower in the patient group compared to the control group, the difference was not statistically significant (P ˃.05). Conclusion: These results suggest that IMA and L-arginine-NO pathway associated with ischemia and oxidative stress may play an important role in the pathogenesis and progression of acne vulgaris.