Ever since I posted the article Skin Signs of Thyroid Disease written by dermatologist Dr. Amanda Oakley, I’ve heard from countless Hypothyroid Mom readers struggling with various skin-related issues. There are two that come up often – acne and melasma. I decided to dig into the research to see why so many of my readers are having these issues.

Melasma & Thyroid Disease

According to Dr. Amanda Oakley at DermNet New Zealand,

Melasma is more common in women than in men; only 1-in-4 to 1-in-20 affected individuals are male, depending on the population studied. It generally starts between the age of 20 and 40 years, but it can begin in childhood or not until middle age. Known triggers for melasma include:

• Sun exposure and sun damage—this is the most important avoidable risk factor
• Pregnancy—in affected women, the pigment often fades a few months after delivery
• Hormone treatments—oral contraceptive pills containing estrogen and/or progesterone, hormone replacement, intrauterine devices and implants are a factor in about a quarter of affected women
• Certain medications (including new targeted therapies for cancer), scented or deodorant soaps, toiletries and cosmetics—these may cause a phototoxic reaction that triggers melasma, which may then persist long term
• Hypothyroidism (low levels of circulating thyroid hormone)

According to the Indian Journal of Dermatology 2006 study Thyroid and Skin,[1]

Hyperpigmentation in thyroid disorders has been reported mainly in hyperthyroidism. Interestingly, we found pigmentary disorders – diffuse hyperpigmentation, melasma, and periocular pigmentation to be a very unusual common complaint in a total of 12 patients (37.5%). The explanation of hyperpigmentation in hyperthyroid patients is increased release of pituitary adrenocorticotropic hormone compensating for accelerated cortical degradation. In hypothyroidism though, the cause of melasma cannot be explained although it has been documented in literature.

The Journal of Dental and Medical Sciences published the article Skin Manifestations of Hypothyroidism – A Clinical Study.[2]

Thyroid disorders are known to cause a wide range of skin manifestations. Hypothyroidism causes changes in the skin, hair and nails. The aim of our study was to evaluate the skin manifestations in patients with hypothyroidism. A total of 100 patients with hypothyroidism attending the General Medicine and Dermatology of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences over a period of one year were included in our study, and the skin lesions have been recorded after a detailed history and clinical examination. Out of 100 patients, 63 patients had skin manifestations. Xerosis (acquired ichthyosis) (abnormally dry skin) and diffuse hair loss were the common skin manifestations which were seen in 38.09% and 34.8% of patients respectively. Melasma(14.28%), chronic urticaria(14.28%) and generalised pruritus(11.1%) were the other common manifestations. Tinea corporis, vitiligo, alopecia areata, lichen planus and xanthelasma palpebrarum were the other skin disorders associated with hypothyroidism.We therefore conclude that a better understanding of the skin lesions helps in the early detection of the underlying hypothyroid state.

Acne & Thyroid Disease

In the 2012 study Association of thyroid autoimmunity with acne in adult women in the Journal of the European Academy of Dermatology and Venereology,[5]

Adult women with acne had a statistically significant increased relative risk to have high levels of anti-TG in comparison with healthy controls. This association was independent of age. Values for TSH, FT4, FT3, T4 and anti-TPO did not significantly differ between the two groups. No significant difference was found regarding the thyroid ultrasound findings. Although there was no significant difference between cases and controls regarding CRP levels, it is interesting that we observed a significant elevation in CRP (C-Reactive Protein) in those acne patients who had positive antithyroglobulin antibodies.

Often times thyroid antibodies for Hashimoto’s, the leading cause of hypothyroidism, are not run on hypothyroid patients. This really blows my mind and I urge every hypothyroid person to push for thyroid antibody testing. There are two thyroid antibodies to test for Hashimoto’s – Thyroid Peroxidase Antibodies and Thyroglobulin Antibodies (also called antithyroglobulin antibodies). Please note that often time when patients push for Hashimoto’s testing, only Thyroid Peroxidase Antibodies are tested. Yes TPOAb antibodies are most common in Hashimoto’s, but it’s important to also have your Thyroglobulin Antibodies. You can see from the above study that this is particularly important if you have acne. This study also brings up the important lab test known as C-Reactice Protein (CRP) which is a measure of inflammation and said to be the best new test to predict heart disease. 220 patients with thyroid disease and 90 healthy individuals as a control group attended a study to compare skin findings of patients with thyroid diseases.[6]

Among 220 cases, in 125 skin findings were detected. The most frequently observed skin findings were chronic urticaria (6.8%), vitiligo (6.8%), diffuse alopecia (6%), acne vulgaris (5%) and acne rosacea (3.6%).

Several times I have heard from Hypothyroid Mom readers struggling with acne who also describe symptoms that jump out at me as possible symptoms of polycystic ovarian syndrome (PCOS) including anvolution (no ovulation) or irregular periods, hirsutism (a male pattern of body or facial hair), and hair loss. Often times they are surprised to hear me ask if they have been tested for PCOS as well as Hashimoto’s. A 2013 study found that in a total of 6 studies involving 1605 women, there was an increased prevalence of autoimmune thyroiditis, increased serum TSH, increased anti-TPO antibodies, and anti-Tg antibodies in women with PCOS when compared to control groups.[7]

There are many possible underlying causes of melasma and acne. The thyroid is not always the cause. However, if you have these skin conditions, be sure to speak to your doctor about full thyroid testing. If you are not diagnosed with hypothyroidism but you wonder if you have it or if you are diagnosed with hypothyroidism but you still struggle with symptoms, please read the article Top 5 Reasons Doctors Fail To Diagnose Hypothyroidism. Get a copy of your lab results and check that you’ve had all the lab tests included in this article and that your levels are optimal not just normal. There is a big difference.

References:

Dogra, A., Dua, A., Singh, P. Thyroid and skin. Indian Journal of Dermatology. 2006;51:96-9.

Haritha, S., Sampath, K.K. Skin Manifestations of Hypothyroidism – A Clinical Study. Journal of Dental and Medical Sciences. 2013;4(2):58-60.

Talaee, R., Ghafarpasand, I., Masror, H. The Relationship Between Melasma and Disturbances in the Serum Level of Thyroid Hormones and Indices. Open Science. 2015;2(2):19-23.

Mogaddam, M.R., Alamdari, M.I., Maleki, N. Ardabili, N. Abedkouhi, S. Evaluation of auotimmune thyroid disease in melasma. J Cosmet Dermatol. 2015 Jun;14(2):167-71.

Vergou, T., Mantzou, E., Tseke, P., Moustou, A.E., Katsambas, A., Alevizaki, M., Antoniou, C. Association of thyroid autoimmunity with acne in adult women. J Eur Acad Dermal Venereol. 2012 Apr;26(4):413-6.

Artantas, S. Gul, U., Kilic, A., Guler, S. Skin findings in thyroid diseases. Eur J Intern Med. 2009 Mar;20(2):158061.

Du D, Li X. The relationship between thyroiditis and polycystic ovary syndrome: a meta-analysis. Int J Clin Exp Med. 2013 Oct 25;6(10):880-9.

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