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Aim: This case-controlled study aimed at evaluating whether enthesitis is possibly associated with acne vulgaris.

Methods: This study was carried out on 90 patients with acne vulgaris and 30 normal individuals who were subjected to full history talking, acne scoring system, general, dermatological, musculoskeletal examination, and musculoskeletal ultrasonography with Doppler flow.

Results: A significant relation (P < 0.05) was discovered between left femoral condyle tenderness, which increased left femoral condyle hypoechogenicity on ultrasound. Moreover, a highly significant relation (P < 0.001) was established between tenderness on clinical examination and hypoechogenicity on ultrasound at three sites (right humerus epicondyle, right femoral condyle, and left humerus epicondyle). An association between tenderness and ultrasound increased thickness was significantly reported in the left femoral condyle (P < 0.05). Hypoechogenicity on ultrasound examination was more statistically evident with increased acne severity at the left Achilles tendon (LA), while enthesis calcifications (enthesophytes) were significantly associated with increased acne severity in the left humerus epicondyle (LA) and the right Achilles tendon (RA) (P < 0.05).

Conclusion: There is a solid possibility acne is a systemic disease triggering other co-morbidities beyond skin which needs to be fully elucidated by further research evidence.