Background: Considering the recognized roles of  ICAM-1 in inflammation and rising an evidence that inflammation is evident at all stages of AV. The current study aimed to investigate the incidence of ICAM-1 gene expression and polymorphism with special reference to amino acids at position 469 and 241 with acne vulgaris and its possible correlation with the lesion severity.  Patient and methods: The present case control study included 60 participants of matched age, sex and of Egyptian origin where there were 45 acne patients assigned into three groups according to acne severity (mild, moderate and severe), 15 patients in each group, and there were 15 participants as control.All studied participants were tested for the genotypes of ICAM-1 gene polymorphism by PCR where four primers have been used to detect all possible polymorphism at codon 241 and 469 Results: There was statistically significant difference among four studied groups as regard ICAM (496) and ICAM (241) polymorphism where the highest percentage of GG were among severe acne group and none of controls had GG genotype. There was significant association between ICAM (496) polymorphism and patients' BMI where the highest BMI  Conclusion: ICAM-1 496 and 241 polymorphism might be associated with AV.  Further understanding of functional significance of the ICAM-1 polymorphism will help delineate immunopathogenesis in certain subgroups of AV obese patients