Aim: To determine the features of hepatic lipid metabolism disorders and intestinal dysbiotic changes in patients with acne vulgaris and metabolic dysfunction-associated steatotic liver disease (MASLD) Materials and Methods: The study included 109 patients: 59 with a combination of acne vulgaris and MASLD and 50 with acne only. Results: It was found that patients with acne and MASLD are more likely to be overweight and have more pronounced changes in hepatic lipid metabolism. Also, patients with combined pathology showed a decrease in the number of the colonic normoflora , as well as an increase in the number of hemolytic forms of E. coli, Enterobacter, Citrobacter, Staphylococcus, Klebsiella, Clostridium, Proteus, Candida spp. Conclusions: Our study highlighted that lipid profile determination and anthropometric examination are important factors in the diagnosis of patients with common acne and MASLD. Our data on changes in the composition of the colonic microflora in patients with comorbidities confirmed the existence of a relationship between the presence of intestinal dysbacteriosis and impaired skin homeostasis.