Effect of systemic isotretinoin use on neutrophil/lymphocyte ratio in acne patients: A retrospective study

Abstract

Objective: Acne vulgaris (AV) describes a chronic inflammatory condition that occurs in the pilosebaceous unit, which is common in the community. Increase in sebum production, abnormal follicular keratinization, Propionibacterium acnes (P.acnes) colonization and inflammation play a role in acne development. ISO, comedolytic, is the only agent that has an effect on all four conditions that determine the pathogenesis of acne, such as a large reduction in sebaceous gland size, suppression of sebum production and reduction in inflammation. In this study, it was aimed to compare the N/L ratio values at the beginning of the treatment and at the 4th month of the treatment in acne vulgaris patients receiving systemic ISO treatment. Material and Method 50 patients with acne vulgaris who applied to the dermatology outpatient clinics of Karaman Training and Research Hospital between October 2020 and February 2021, had moderate and severe acne vulgaris and were started on oral isotretinoin were included in the study. The medical records of the patients were reviewed retrospectively. The neutrophil/lymphocyte (N/L) ratio values of the patients at the beginning of Isotretinoin treatment and after four months were recorded. Results The mean age of the patients was 23.1±6.23, 52.0% (26 persons) were male. There was a significant decrease in the N/L ratio in total and in both genders with isotretinoin use (p<0.01). A positive correlation was found between the initial and post-treatment N/L rates. Conclusion Prospective studies with larger series and control groups may show that N/L ratio may be an important parameter in the follow-up of acne vulgaris patients receiving systemic therapy.

Keywords

• : acne vulgaris
• severe acne
• systemic therapy
• isotretinoin
• neutrophil-lymphocyte ( ratio
• inflammation

Project Number

yok

Akne hastalarında sistemik izotretinoin kullanımının nötrofil/lenfosit oranı üzerine etkisi: Retrospektif bir çalışma

Abstract

Özet Amaç Akne vulgaris (AV),toplumda sık rastlanan , pilosebase ünitede ortaya çıkan kronik inflamatuar bir durumu tanımlar. Akne gelişiminde sebum üretiminde artış, anormal foliküler keratinizayon, Propionibacterium acnes (P.acnes) kolonizasyonu ve inflamasyon rol alır. ISO, komedolitik, sebase bez boyutlarında büyük oranda küçülme,sebum üretimini baskılama ve enflamasyonda azalma gibi akne patogenezini belirleyen dört durumun hepsine etkisi bulunan tek ajandır. Bu çalışmada, sistemik İSO tedavisi alan akne vulgaris hastalarında tedavi başlangıcında ve tedavinin 4. Ayında N/L oranı değerlerinin karşılaştırılması amaçlanmıştır. Yöntem Ekim 2020-Şubat 2021 tarihleri arasında Karaman Eğitim ve Araştırma Hastanesi Dermatoloji polikliniklerine başvuran,orta ve şiddetli akne vulgarisi olan ve oral izotretinoin başlanan 50 akne vulgaris tanılı hasta çalışmaya alındı. Hastaların tıbbi kayıtları retrospektif olarak incelendi.Hastaların izotretinoin tedavisi başlangıcında ve dört ay sonrasındaki nötrofil /lenfosit(N/L) oranı değerleri kaydedildi. Bulgular Hastaların yaş ortalaması 23,1±6,23, %52,0 (26 kişi) erkekti. İzotretinoin kullanımı ile N/L oranında toplamda ve her iki cinsiyette anlamlı düşüş vardı (p<0,01). Başlangıç ve tedavi sonrası N/L oranları arasında pozitif korelasyon tespit edildi. Sonuç Daha geniş serilerde ve kontrol grupları ile yapılacak prospektif çalışmalar,sistemik tedavi alan akne vulgaris hastalarının takibinde N/L oranının önemli bir parametre olabileceğini gösterebilir.

Keywords

• akne vulgaris
• şiddetli akne
• sistemik tedavi
• İzotretinoin
• Nötrofil/Lenfosit oranı
• inflamasyon

Supporting Institution

yok

Project Number

yok

References

1. 1.Kraft, J. ,A. Freiman, Management of acne. . CMAJ : Canadian Medical Association journal .2011;183(7): 430-5.
2. 2. Nast A, Dreno B, Bettoli V, et al. European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermatol Venereol. 2012;26:1-29.
3. 3. Brelsford M, Beute TC. Preventing and managing the side effects of isotretinoin. Semin Cutan Med Surg. 2008;27:197- 206.
4. 4. Dolan RD, Lim J, Mcsorley ST, et al. The role of the systemic inflammatory response in predicting outcomes in patients with operable cancer: systematic review and meta-analysis. Sci Rep 2017;7(1):16717.
5. 5. Horne BD, Anderson JL, John JM, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005;45(10):1638-43.
6. 6. Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil–lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta. 2008;395(1-2):27-31.
7. 7.Balta S, Kurtoglu E, Kucuk U, Demirkol S, Ozturk C. Neutrophil– lymphocyte ratio as an important assessment tool. Expert Rev Cardiovasc Ther. 2014;12(5):537-538.
8. 8. Balta S, Ay SA, et al. The comparative effects of valsartan and amlodipine on vWf Levels and N/L ratio in patients 408 Clinical and Applied Thrombosis/Hemostasis 22(5) with newly diagnosed hypertension. Clin Exp Hypertens. 2013; 35(7):516-22.

9. 9. Doshi A, Zaheer A, Stiller MJ. A comparison of current acne grading systems and proposal of a novel system. Int J Dermatol 1997;36:416-8.
10. 10. Picardo M, Ottaviani M, Camera E, et al. Sebaceous gland lipids. Dermatoendocrinol. 2009;1(2):68-71.
11. 11. Toyoda, M., M. Morohashi. Pathogenesis of acne. Med Electron Microsc, 2001. 34(1): 29-40.
12. 12. Jeremy AH, Holland DB, Roberts SG, et al. Inflammatory events are involved in acne lesion initiation. J Invest Dermatol. 2003 ;121(1):20-7.
13. 13. Kara A, Guven M, Yilmaz MS, et al. Are neutrophil, platelet and eosinophil-to-lymphocyte ratio and red blood cell distribution width can be used for nasal polyposis? Eur Arch Otorhinolaryngol. 2018; 275:409-13.
14. 14. Jean L. Bolognia, J.V.S., Lorenzo Cerroni. Acne vulgaris. In: BologniaJL, Jorizzo JL, Rapini RP, editors. Dermatology. 4th ed. St Louis: Mosby Dermatology. 2018. p. 588-603.
15. 15. Özuğuz P. , Kaçar S. , Polat S. et al. Isotretinoin Tedavisinin Nötrofil/Lenfosit Orani Ve Diğer Hemogram Parametrelerine Etkisinin Değerlendirilmesi. The Med J of Mustafa Kemal University. 2015; 4(13): 9-14.
16. 16. Karadag AS, Ertugrul DT, Takci Z. Isotretinoin modestly increases platelet count in acne patients. J Dermatolog Treat. 2013;24(2):139-40.