1. Women who reported a history of severe acne were more likely to be diagnosed with endometriosis.
2. A history of severe acne was independently associated with endometriosis.
Evidence Rating Level: 2 (Good)
Study Rundown: Endometriosis is a common gynecological disorder defined by the presence of extrauterine endometrial glands and stroma. While the condition is asymptomatic in some women, it can cause significant chronic pelvic pain, dysmenorrhea, dyspareunia and infertility. Diagnosis requires laparoscopy with pathologic confirmation such that the invasive nature of diagnosis often delays recognition and treatment. Currently, treatment options include surgical therapies (ablation or excision of implants), or medical treatment (NSAIDs, oral contraceptives or GnRH agonists). The pathogenesis of endometriosis has yet to be definitively established, but it is known that the growth of implants is estrogen-dependent. Previous studies have shown that a single nucleotide polymorphism, that is also associated with severe teenage acne, shared a chromosomal location with c-myc, thought to be a regulator of cellular proliferation in endometriosis.
The present work is the first to prospectively, directly evaluate the relationship between acne and endometriosis. The authors found that severe teenage acne was independently associated with endometriosis after accounting for the effects of known risk factors.
Limitations of the study include potential introduction of bias due to self-reported acne. Additionally, laparoscopic confirmation of endometriosis is not as specific as pathologic confirmation, the gold standard for diagnosis such that it is possible, albeit improbable that the association identified herein applies to visualization of implants but not necessarily endometriosis pathology. Future studies in a more diverse population are needed. Inclusion of women with clinical diagnoses of endometriosis (who lack surgical and/or pathologic confirmation) should be considered, as they comprise a large proportion of affected patients. Further bench work delineating the pathogenesis of endometriosis would provide more insight into teleological explanations for the relationship between acne and endometriosis.
Relevant Reading: Genetics and genomics of endometriosis
In-Depth [prospective cohort]: This study evaluated the relationship between self-reported severe acne during teenage years and risk of endometriosis. The primary outcome of interest was laparoscopically-confirmed diagnosed of endometriosis. Women who self-reported severe teenage acne were more likely to be diagnosed with endometriosis (HR 1.20, CI 1.08-1.32). This association remained statistically significant after accounting for history of infertility, hair color and sunburn history, which have demonstrated associations with endometriosis.
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