Acne Vulgaris May Trigger Inflammation of the Entheses

ankle pain
“A hurting ankle, maybe an inversion fracture. XXL size image.”
Whether enthesitis might be associated with acne vulgaris was the researchers’ aim in this case‐controlled study.

Acne may be a systemic condition capable of triggering other non-skin-related comorbidities, including enthesitis, according to study data published in the Journal of Cosmetic Dermatology.

A total of 90 patients with acne (mean age, 19.5±2.9 years) and 30 people without acne (mean age, 20.1±2.3 years) were included in the study. The acne group included 30 patients with mild acne, 30 patients with moderate acne, and 30 patients with severe acne.

The Leeds Enthesitis Index (LEI) score was applied to examine tenderness at the insertion of bilateral Achilles tendon (RA, LA), medial femoral condyles (RF, LF), and lateral humeral epicondyles (RH, LH).

A musculoskeletal ultrasound was also performed. Enthesitis features were also assessed. These features included hypoechogenicity, enthesophytes, increased thickness, calcifications, erosions, cortical irregularities, associated bursitis, and power Doppler.

A total of 34 of 540 entheses were tender in the 90 clinically examined patients. Patients had significantly higher thickness compared with control group participants at all 6 LEI sites (P <.01), but there was no difference at the RH, LH, and LF sites in terms of mean thickness.

In addition, patients had significantly higher ultrasonographic hypoechogenicity at RF (P =.008) and LF (P =.013). There was no difference between the groups in terms of erosions and calcifications.

The investigators observed a significant association between tenderness and ultrasound increased thickness in the left femoral condyle (P <.05). Also, ultrasound-detected hypoechogenicity was significantly associated with increased acne severity at the LA. Enthesis calcifications were also associated with increased acne severity in the left humerus epicondyle and RA (P <.05).

The primary limitation of the study is its small sample size, which may limit the applicability of the findings across larger, more diverse patient groups, it was noted.

According to the investigators, there is “a solid possibility acne is a systemic disease triggering other co-morbidities beyond skin,” which is “in line with overlapping immunopathogenesis of acne and enthesitis and with the new emerging immunological insights into their developments.”


Abdellatif AA, Hasan MS, Fahmy AM, Mahmoud OE, Elsaie ML. Assessment of enthesopathy in patients with acne vulgaris: a case-controlled trial. J Cosmet Dermatol. Published online February 24, 2021. doi:10.1111/jocd.14028