Could severe teen acne signal risk of endometriosis?

According to a recent prospective cohort study in Human Reproduction, women who have a history of severe acne in their adolescent years may be at greater risk of developing endometriosis.

Researchers from Harvard Medical School and other institutions used data from 88,623 female nurses, which was collected from September 1989 to June 2009 as part of the Nurses’ Health Study II (NHS II) cohort. Multivariate models were adjusted to account for established risk factors of endometriosis and confidence intervals (CIs) and hazard ratios (HRs) were calculated with regression models.

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In the cohort, laparoscopically confirmed endometriosis cases were documented in 4382 women in 1,132,272 woman-years of follow up. When compared to women who had no history of severe teenage acne, those who did have a history of severe teenage acne were found to have a 20% increased risk of endometriosis (HR = 1.20, 95% CI: 1.08 – 1.32). Adjusting for the use of tetracycline or isotretinoin did not affect the association.

Investigators cautioned that the HR could be underestimated because only endometriosis cases confirmed by laparoscopy were included. Also, while the geographic area covered in the cohort is diverse, the NHS II cohort was predominantly white, potentially limiting generalization in other ethnically diverse populations.

The authors concluded that their study suggests that severe acne during adolescence is associated with an increased risk of endometriosis. They also believe that acne may be useful in early detection of endometriosis because it is a visible and noninvasive clinical indicator.

Comment from Jon I Einarsson, MD, PhD, MPH:

Although there was a statistically significant difference, the HR of 1.2 probably has a very low PPV and therefore is not a very helpful tool in clinical practice. I don’t think a history of severe acne would change my decision making one bit to take someone in for surgery for suspected endometriosis.

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