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All of us have been dealing with acne at one point or another.
When you’re a teenager acne is one of the biggest concerns you have. At that point, we expect this problem will go away when we’re older.
However, acne breakouts can occur in adulthood too. Reasons behind acne breakouts are numerous, but the question is whether thyroid disease is one of them. Get your answers below.
Brief acne overview
Acne is defined as a skin condition that occurs when hair follicles become clogged with dead skin cells and sebum (oil). Not all acne cases are the same, they can be inflammatory or anti-inflammatory.
We can divide them further into cysts, blackheads, whiteheads, nodules, pustules, and papules. An affected individual can develop different acne types at the same time[i].
The American Academy of Dermatology reports that acne is the most common skin condition in the United States. This skin problem affects up to 50 million Americans annually. About 85% of people 12-24 years old deal with at least minor acne. The costs of acne treatment go up to $3 billion a year[ii].
Although teenagers are more prone to acne the truth is that they can affect all people. Regardless of a person’s age, acne breakouts have a major impact on confidence and psychological wellbeing.
Figures show that 96% of survey responders report feeling depressed over their condition while 46% report low self-esteem and 31% people decline attending social gatherings due to their skin problem[iii].
Acne usually appears on the face and forehead, but they can affect chest, upper back, and shoulders too. The primary cause of acne is, as mentioned above, excessive production of sebum.
Other causes include bacteria, dead skin cells, ingrown hairs, medications, stress, heredity or genetics, and hormonal imbalances.
Can thyroid function and its hormones also contribute to acne?
Skin has thyroid receptors
The idea that thyroid diseases could contribute to acne breakouts may seem a bit odd to most people, but it’s not such a surprise when you bear in mind that your skin has thyroid receptors.
Safer J.D. published a paper which revealed that direct thyroid hormone action on the “skin is mediated through thyroid hormone receptors”. In fact, all three “recognized thyroid hormone binding isoforms of thyroid receptors” have been identified in skin’s tissues.
Thyroid receptors have been found in sebaceous glands (produce sebum or oil), “epidermal keratinocytes, skin fibroblasts, hair arrector pili muscle cells, vascular endothelial cells.” Interestingly, “several thyroid hormone-responsive genes” have been identified in the skin as well[iv].
Despite thyroid receptors’ presence in the skin, the influence of this gland on skin changes is insufficiently studied. Speaking of thyroid diseases and skin problems, Artantaş S. et al carried out a study which included 220 patients with thyroid diseases and 90 healthy individuals to evaluate the prevalence of skin diseases.
They found that among 220 people with thyroid diseases, 125 (56.8%) experienced skin changes. The most frequent skin changes included chronic urticaria (6.8%), diffuse alopecia (6%), acne vulgaris (5%), and acne rosacea (3.6%)[v].
Acne and thyroid autoimmunity
While thyroid diseases are well-researched, their impact on skin problems and changes affecting the largest organ of our body isn’t studied well enough, as mentioned above.
Although evidence on this subject isn’t plentiful as it is on some other aspects of thyroid disease, it is still possible to conclude that diseases affecting the butterfly-shaped gland do contribute to the development of acne.
The Journal of the European Academy of Dermatology and Venerology published an interesting study whose primary objective was to assess the relationship between thyroid disorder and the presence of post-adolescent acne in adult women compared to controls. For this purpose, Vergou T. et al included 107 adult women with post-adolescent acne and 60 women in control group.
In order to find answers about this subject, scientists performed thyroid ultrasound on all participants.
Plus, they analyzed complete blood count and standard biochemical profile of C-reactive protein (CRP), levels of thyroid hormones and antibodies (T3, T4, TSH or thyroid stimulating hormone, free T3 (fT3), and free T4 (fT4), anti-thyroglobulin antibodies or anti-TG, and anti-thyroid peroxidase antibodies or anti-TPO.
Findings revealed the significant difference in the prevalence of positive anti-TG antibodies. In fact, 25.2% of women in the acne group had elevated anti-TG compared to only 8.3% of their counterparts from the control group.
Scientists elaborated that post-adolescent women with acne had a significantly higher risk of having high anti-TG levels than women from the same age group without acne.
Interestingly, levels of thyroid hormones and anti-TPO didn’t differ across groups. Thyroid ultrasound didn’t detect some major differences either. That said, women from acne group with positive anti-TG also had higher levels of CRP.
The C-reactive protein or CRP is a substance produced by the liver in response to inflammation. Elevated concentration of CRP indicates the existence of inflammation, which is deeply associated with thyroid autoimmunity.
A common case of thyroid autoimmunity is Hashimoto’s thyroiditis, the most common cause of hypothyroidism.
Scientists concluded that thyroid autoimmunity is common in adult patients with acne. Women with acne are encouraged to talk to their healthcare providers about potential thyroid problems. At the same time, doctors should keep this relationship in mind when dealing with adult patients with acne[vi].
In many cases, this relationship is neglected because thyroid antibodies for Hashimoto’s thyroiditis aren’t analyzed in hypothyroid patients. That’s why adult patients with acne are encouraged to consult their doctors, but at the same time, physicians should consider running these tests as well.
Also, in some cases when patients ask for Hashimoto’s testing, only TPOab (thyroid peroxidase antibodies) is tested, not anti-TG which is also crucial as seen in the above-mentioned study.
Speaking of Hashimoto’s thyroiditis, Du D. and Li X. carried out a review of studies about the relationship between this autoimmune thyroid disease and polycystic ovary syndrome (PCOS). They evaluated 6 studies with a total of 726 PCOS patients and 879 controls.
Scientists discovered the increase in serum TSH levels, elevated anti-TPO, and higher anti-TG in women with polycystic ovary syndrome compared to controls. Basically, this means that Hashimoto’s and PCOS are significantly associated with one another[vii].
A study from the Journal of Cosmetic Dermatology found that PCOS is an important contributing factor to the formation of acne. Maluki A.H. discovered that out of 123 women with PCOS, 63 patients (51.2%) had acne[viii].
Cholesterol and acne
At this point, there are no studies that confirm hypothyroidism induces acne breakouts. The importance of new studies on this subject becomes even greater. That said, above-mentioned studies found a link between Hashimoto’s and acne, which is still a major discovery.
Yet another indirect mechanism that connects hypothyroidism and acne is cholesterol level. Ekiz O. et al carried out a study whose objective was to analyze the status of thyroid functions and lipid levels in participants with post-adolescent acne.
They enrolled 184 patients with acne and 82 healthy controls. Then, researchers analyzed thyroid function and lipid profiles in each participant.
According to results, published in the International Journal of Dermatology, no major differences were observed between patients with post-adolescent acne and healthy controls in total cholesterol, LDL, and triglyceride levels.
At the same time, thyroid hormone levels remained similar across groups as well. That said, patients with acne had a significantly lower concentration of HDL cholesterol compared to their counterparts[ix].
As you’re already aware, hypothyroidism is associated with higher LDL and lower HDL cholesterol levels. For example, Carantoni M. et al discovered that hypothyroid subjects have particularly low HDL levels compared to euthyroid participants[x].
Weight gain and acne
Weight gain is one of the most prevalent symptoms of hypothyroidism. A growing body of evidence confirms the strong link between body composition and concentration of thyroid hormones.
The relationship between thyroid function and body weight stems from the fact that thyroid hormones regulate basal metabolism, thermogenesis, and they play a significant role in glucose and lipid metabolism, fat oxidation, and food intake.
Hypothyroidism is strongly associated with decreased metabolic rate, lower thermogenesis, higher prevalence of obesity, and bigger BMI. Even mild thyroid dysfunction such as subclinical hypothyroidism can lead to overweight and obesity[xi].
Halvorsen J.A. et al inspired prevalence of higher BMI among girls and boys with acne. They found no relationship between acne and BMI in boys, but girls were different. Overweight and obesity were strongly associated with acne breakouts[xii].
Since acne is linked to excess weight which also happens to be a major symptom of hypothyroidism, we can observe yet another mechanism that indicates a connection between the butterfly-shaped gland and acne formation.
Acne medication and thyroid
Throughout this article, we have investigated the relationship between thyroid function and development of acne. Even though evidence on this subject is limited, the relationship is evident. However, the association between acne and thyroid is a two-way street. You see, fight against acne can affect thyroid function.
Yildirim N. et al conducted a study to find out whether treatment with isotretinoin changed the serum thyroid function tests of patients with acne vulgaris. Isotretinoin is a prescription drug that is commonly used for the treatment of severe acne.
According to Drugs.com, Isotretinoin is a form of vitamin A and it works to reduce the production of sebum. The medication is prescribed only in instances when other treatments, including antibiotics, for acne are ineffective[xiii].
For the purpose of their study, a group of scientists from Turkey enrolled 51 participants (29 women and 22 men) with severe acne vulgaris. Subjects were treated with 120mg/kg dose of isotretinoin. Their fT3, fT4, and TSH were measured at the beginning of the study, after three months, and six months after the onset of the treatment.
Following the treatment with isotretinoin, levels of TSH increased significantly, but the concentration of fT3 and fT4 decreased. Scientists concluded that therapy with isotretinoin induces changes in serum thyroid function tests, but more research is needed to evaluate long-term effects.
Tips to combat acne
Nobody likes acne, that’s a fact. Seeing those little bumps on the face can affect one’s self-esteem and create a negative body image. Sure, acne is stubborn, but there are many things one can do to put up a good fight:
- Have a regular skin care routine (morning and before bed)
- Use a gentle cleanser, harsh cleansers could encourage skin to produce more sebum
- Use a face cream that is formulated specifically for acne-prone skin
- Consult your doctor and let them know about your acne struggle
- Wash your face gently, don’t scrub
- Avoid using foundations and powders on your face until acne clears out
- Remove makeup before bedtime
- Keep hands off your face
- Modify your diet, avoid junk food, increase intake of fruits and vegetables
- Reduce stress
- Maintain weight in a healthy range
- Exercise regularly
Acne is the most common skin problem in the US, and possibly around the globe. Causes of acne are numerous and thyroid dysfunction could be one of them.
Although current evidence confirms the link between acne and thyroid, more research is needed to elucidate this relationship into a greater detail.
[i] Types of acne and how to treat them, Healthline https://www.healthline.com/health/beauty-skin-care/types-of-acne
[ii] Acne, American Academy of Dermatology https://www.aad.org/media/stats/conditions
[iii] The facts behind the acne statistics 2017, AcnEase https://www.acneaseeu.com/acne-treatment-blog/the-facts-behind-the-acne-statistics-2017.htm
[iv] Safer JD. Thyroid hormone action on skin. Dermato-endocrinology. 2011;3(3):211-215. doi:10.4161/derm.3.3.17027. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219173/
[v] Artantaş S, Gül U, Kilic A, Güler S. Skin findings in thyroid diseases. European Journal of Internal Medicine 2009 Mar;20(2):158-61. Doi: 10.1016/j.ejim.2007.09.021 https://www.ncbi.nlm.nih.gov/pubmed/19327604
[vi] Vergou T, Mantzou E, Tseke P, et al. Association of thyroid autoimmunity with acne in adult women. Journal of the European Academy of Dermatology and Venerology 2012 Apr;26(4):413-6. Doi: 10.1111/j.1468-3083.2011.04084.x. https://www.ncbi.nlm.nih.gov/pubmed/21521376
[vii] Du D, Li X. The relationship between thyroiditis and polycystic ovary syndrome: a meta-analysis. International Journal of Clinical and Experimental Medicine 2013 Oct 25;6(10):880-9. https://www.ncbi.nlm.nih.gov/pubmed/24260593
[viii] Maluki AH. The frequency of polycystic ovary syndrome in females with resistant acne vulgaris. Journal of Cosmetic Dermatology 2010 Jun;9(2):142-8. Doi: 10.1111/j.1473-2165.2010.00500.x https://www.ncbi.nlm.nih.gov/pubmed/20618560
[ix] Ekiz O, Balta I, Unlu E, et al. Assessment of thyroid function and lipid profile in patients with postadolescent acne in a Mediterranean population in Turkey. International Journal of Dermatology 2015 Dec;54(12):1376-81. Doi: 10.1111/ijd.12547 https://www.ncbi.nlm.nih.gov/pubmed/25771990
[x] Carantoni M, Vigna GB, Stucci N, et al. Low levels of HDL cholesterol in hypothyroid patients with cardiovascular disease. Minerva Endocrinologica 1997 Dec;22(4):91-7 https://www.ncbi.nlm.nih.gov/pubmed/9586415
[xi] Sanyal D, Raychaudhuri M. Hypothyroidism and obesity: An intriguing link. Indian Journal of Endocrinology and Metabolism. 2016;20(4):554-557. doi:10.4103/2230-8210.183454. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4911848/
[xii] Halvorsen JA, Vleugels RA, Bjertness Espen, et al. A population-based study of acne and body mass index in adolescents. JAMA Dermatology 2012 Jan;148(1):131-2. Doi: 10.1001/archderm.148.1.131 https://jamanetwork.com/journals/jamadermatology/fullarticle/1105449
[xiii] Isotretinoin, Drugs https://www.drugs.com/mtm/isotretinoin.html