Thyroid autoimmunity in female post-adolescent acne: A case-control study.

Acne vulgaris is an incompletely understood disorder of poliosebaceous follicles. A scourge of adolescence, it is increasingly persisting into the mid-forties, especially in females. 45% of women aged 21–30 years, 26% aged 31–40 years, and 12% aged 41–50 years, suffer from clinically-visible acne.1 The reasons for this rising prevalence have been unclear. Polycystic ovarian syndrome (PCOS) has been suggested as a possible contributor, however most acne sufferers have normal serum androgen levels.2,3 There has been increasing suspicion of a key autoinflammatory role in pathogenesis of chronic acne vulgaris. Autoinflammatory syndromes associated with acne have been described as possibly sharing common pathogeneses, involving dysregulated immunity with abnormal interleukin-1 signaling, leading to clinically significant inflammation.4,5 Thyroid autoimmunity has been detected in a number of chronic inflammatory skin conditions including acne vulgaris and chronic idiopathic urticaria.6,7 In 2012, Vergou and colleagues were the first to show female post-adolescent acne sufferers had significantly higher rates of thyroid autoimmunity compared with healthy controls.7 The relationship has not been examined since, despite a sound theoretical grounding. We aimed to confirm this association between thyroid autoimmunity and post-adolescent acne in adult women, as well as qualify its practical value with subsequent endocrinologist referral and intervention.