Patients with Acne at an Increased Risk of Gastrointestinal Issues

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Patients with acne are at an increased risk of gastrointestinal comorbidities, particularly those with more severe cases. For these patients, consultation with a gastroenterologist may be beneficial.

Acne affects approximately 9.4% of the global population and is caused by factors such as abnormal follicular keratinization, microbial colonization by Cutibacterium acnes, inflammation and excessive sebaceous gland secretion. It is linked to a variety of comorbidities, including psychiatric conditions such as depression and suicidal risk, especially with isotretinoin use, as well as endocrine-related diseases predominantly affecting women with adult-onset acne.

“Although some studies have investigated on bowel habits in patients with acne vulgaris and irritable bowel syndrome (IBS), the results have been controversial results,” wrote a team of investigators led by Yu-Wen Chen, M.D., associated with the Department of Dermatology at Taichung Veterans General Hospital, Taiwan.

The study aimed to determine the relationship between acne vulgaris and gastrointestinal comorbidities, considering age, sex and antibiotic use.

Investigators conducted a nationwide case-control study using information from Taiwan’s National Health Insurance Research Database (NHIRD) between 1997 and 2013, comparing 185,491 patients with acne with age- and sex-matched controls. In order to confirm the accuracy of acne diagnosis, only those with at least three outpatient visits were included in the analysis. Conditional logistic regression was used to evaluate the link between acne and gastrointestinal conditions.

The database comprises comprehensive records of both inpatient and outpatient visits for 99% of individuals living in Taiwan, and includes information on medications, laboratory tests and medical procedures. However, personal information, such as body weight, height, family history, results of laboratory tests, and lifestyle and habits are not available through the NHIRD.

Among the patients with acne, 4.4% (8,786 individuals) were diagnosed before the age of 12 years, 63.8% (127,096 individuals) developed acne between the ages of 12 and 25 years, and 31.8% (63,262 individuals) were diagnosed after age 25. According to data from NHIRD, acne was more prominent in female patients.

Approximately 37% of patients with acne were prescribed systemic antibiotics at some point, with 41% of adolescents exhibiting a higher percentage of extended antibiotics usage, indicating moderate to severe acne.

Patients with acne showed significantly higher risks of gastrointestinal comorbidities, such as peptic ulcers, IBS, gastroenteritis, gastroesophageal reflux disease (GERD) and constipation. These risks were particularly pronounced in patients aged 12 years and older, and those with moderate to severe acne, regardless of antibiotic use.

In children under 12 years, IBS and constipation were associated with acne, although this was not deemed statistically significant. The study also demonstrated people with acne have a higher risk of developing gastrointestinal conditions in the future, especially for those with more severe acne who use antibiotics. This risk is particularly notable in younger children.

Although the study explores the link between acne and gastrointestinal conditions, supporting the “gut-skin axis theory,” investigators noted limitations including missing data on family history, acne severity, diet, lifestyle, body mass index and isotretinoin use. Potential miscoding and misclassifications could also affect the accuracy of the results. Efforts were made to minimize selection bias through specialist diagnoses, but the findings are based on a Taiwanese population and may not be generalizable to other groups.

“Our 13-year population-based study revealed that patients with acne have an overall elevated risk of experiencing gastrointestinal comorbidities, including peptic ulcers, IBS, constipation, gastroenteritis and GERD, regardless of age difference,” investigators concluded.