AKNE ŞİDDETİNİN İNFLAMATUAR VE METABOLİK BELİRTEÇLER İLE İLİŞKİSİ: PROSPEKTİF KESİTSEL BİR ÇALIŞMA

Yıl 2023, Cilt: 25 Sayı: 2, 293 - 302, 31.08.2023

Zuhal Metin , Kağan Tur , Serkan Akogul , Nazime Bensu Önentaşçı Demir

https://doi.org/10.24938/kutfd.1318356

Öz

Amaç: Bu çalışmada inflamatuar ve metabolik belirteçlerin akne şiddeti ve birbirleri ile olan ilişkilerini incelemek, bu belirteçlerin akne mekanizmasındaki farklı inflamatuar ve metabolik yollardaki etkinliklerini bir bütün olarak araştırmak amaçlanmıştır.

Gereç ve Yöntemler: Çalışmamız akne tanısı almış 203 hasta ile prospektif kesitsel bir çalışma olarak yürütüldü. Akne şiddeti “International Consensus Conference on Acne Classification System” ’e göre hafif, orta ve ağır olarak üç sınıfa ayrıldı. Hastaların inflamatuar ve metabolik belirteçlerinden fibrinojen/albümin oranı (FAO), D-dimer/albümin oranı (DAO), ürik asit/HDL oranı (UHO), CRP, sedimantasyon (ESH), lökosit sayısı (WBC), D-vitamini, trigliserid (TG) ve HOMA-IR değerlerine bakıldı. Elde edilen değerlerin akne şiddeti ve birbirleri ile ilişkileri incelendi. İstatiksel test olarak Mann- Whitney U testi, Kruskal-Wallis H testi ve Spearmans korelasyon analizinden faydalanıldı.

Bulgular: Çalışmamızda CRP (p=0.008), WBC (p=0.006) ve yeni inflamatuar belirteçlerden UHO’nun (p<0.001) akne şiddeti ile anlamlı derecede ilişkili olduğu gözlenmiştir. Ayrıca D vitamini eksikliğinin akne şiddetini arttırıcı etkisi (p=0.074) dikkat çekmiştir. Tanımladığımız belirteçlerin birbirleriyle ilişkileri incelendiğinde; ESH-CRP, ESH-FAO, ESH-HOMAIR, ESH-DAO, CRP-WBC, CRP-FAO, CRP-UHO, CRP-TG, WBC-UHO, WBC-TG, FAO-HOMAIR, FAO-DAO, HOMAIR-UHO, HOMAIR-DAO, HOMAIR-TG, UHO-TG, D vitamini-TG aralarında anlamlı pozitif korelasyonlar saptanmıştır.

Sonuç: Akne oluşum mekanizmasının multifaktöriyel ve karmaşık yapısı nedeniyle metabolik ve inflamatuar birçok belirtecin şiddet ve prognoz tayininde kombine olarak kullanılması daha faydalı olacaktır. Bununla birlikte farklı inflamatuar ve metabolik yolları hedefleyebilecek potansiyel yeni tedavi yöntemlerinin de geliştirilmesi açısından kapsamlı çalışmaların artması gerekmektedir.

Anahtar Kelimeler

Akne, akne şiddeti, inflamasyon, laboratuvar belirteçleri

The Association of Acne Severity with Inflammatory and Metabolic Markers: A Prospective Cross-sectional Study

Öz

Objective: This study aimed to investigate the relationships between acne severity with inflammatory and metabolic markers, and their interplay. Additionally, the study sought to explore the overall activity of these markers within different inflammatory and metabolic pathways in the mechanism of acne.

Material and Methods: Our study was conducted as a prospective cross-sectional study with 203 patients diagnosed with acne. Acne severity was categorized into three classes: mild, moderate, and severe, according to the "International Consensus Conference on Acne Classification System". We evaluated inflammatory and metabolic markers, including fibrinogen/albumin ratio (FAR), D-dimer/albumin ratio (DAR), uric acid/HDL ratio (UHR), CRP levels, sedimentation rate (ESH), leukocyte count (WBC), vitamin D, triglyceride (TG) and HOMA-IR values in the patients. The relationships between these markers and acne severity, as well as their interrelationships, were examined. Mann-Whitney U test, Kruskal-Wallis H test, and Spearman's correlation analysis were employed for statistical analysis.

Results: It was observed that CRP (p=0.008), WBC (p=0.006) and the novel inflammatory marker UHR (p<0.001) were significantly associated with acne severity. Additionally, it is worth noting the notable impact of vitamin D deficiency on exacerbating acne severity (p=0.074). In the relationships between the markers we defined; there were significant positive correlations between ESH-CRP, ESH-FAO, ESH-HOMAIR, ESH-DAO, CRP-WBC, CRP-FAO, CRP-UHO, CRP-TG, WBC-UHO, WBC-TG, FAO-HOMAIR, FAO-DAO, HOMAIR-UHO, HOMAIR-DAO, HOMAIR-TG, UHO-TG and vitamin D-TG.

Conclusion: Due to the multifactorial and complex nature of acne pathogenesis, the combined use of multiple metabolic and inflammatory markers would be more beneficial in determining severity and prognosis. Comprehensive studies are needed to develop potential new treatment methods that can target different inflammatory and metabolic pathways.

Anahtar Kelimeler

Acne, acne severity, inflammation, laboratory markers

Kaynakça

• Pathogenesis, clinical manifestations, and diagnosis of acne vulgaris - UpToDate [Internet]. [cited 2023 Jun 20]. Available from: https://www.uptodate.com/contents/pathogenesis-clinical-manifestations-and-diagnosis-of-acne-vulgaris
• Karadağ AS, Balta İ, Saricaoğlu H, Kiliç S, Kelekçi KH, Yildirim M et al. The effect of personal, familial, and environmental characteristics on acne vulgaris: A prospective, multicenter, case controlled study. G Ital Dermatol Venereol. 2019;154(2):177-85. 
• Chen T, Chen Y, Shao X, Chen J, Liu L, Li Y, et al. Hematological parameters in patients with acnes. J Cosmet Dermatol. 2023;22(7):2099-104.
• Nagpal M, De D, Handa S, Pal A, Sachdeva N. insulin resistance and metabolic syndrome in young men with acne. JAMA Dermatol. 2016;152(4):399-404.
• Biagi LG, Sañudo A, Bagatin E. Severe acne and metabolic syndrome: A possible correlation. Dermatology. 2019;235(6):456-62.
• Snast I, Dalal A, Twig G, Astman N, Kedem R, Levin D, et al. Acne and obesity: A nationwide study of 600,404 adolescents. J Am Acad Dermatol. 2019;81(3):723-9.
• Halvorsen JA. A population-based study of acne and body mass index in adolescents. Arch Dermatol. 2012;148(1):131-2.
• Melnik BC, Schmitz G. Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Exp Dermatol. 2009;18(10):833-41.
• Sobhan M, Seif Rabiei MA, Amerifar M. Correlation between lipid profile and acne vulgaris. Clin Cosmet Investig Dermatol. 2020;13:67-71.
• Rasti S, Dewinta N, Kamal R, Adissadah A, Madanny A, Dewanti L. Correlation between serum 25-hydroxy vitamin D levels and the severity of acne vulgaris: A systematic review. Indian J Dermatol. 2022;67(1):31-6.
• Wang M, Zhou Y, Yan Y. Vitamin D status and efficacy of vitamin D supplementation in acne patients: A systematic review and meta‐analysis. J Cosmet Dermatol. 2021;20(12):3802-7.
• Pochi PE, Shalita AR, Strauss JS, Webster SB, Cunliffe WJ, Irving Katz H, et al. Report of the consensus conference on acne classification. J Am Acad Dermatol. 1991;24(3):495-500.
• Dhaked DR, Meena RS, Maheshwari A, Agarwal US, Purohit S. A randomized comparative trial of two low-dose oral isotretinoin regimens in moderate to severe acne vulgaris. Indian Dermatol Online J. 2016;7(5):378-85.
• Yıldırım F, Mert B, Çağatay EY, Aksoy B. Predictors of quality of life in adults and adolescents with acne: A cross-sectional study. Indian J Dermatol. 2022;67(3):239-46.
• Tan JKL, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015;172(Suppl):3-12.
• Gupta A, Sharma Y, Dash K, Chaudhari N, Jethani S. Quality of life in acne vulgaris: Relationship to clinical severity and demographic data. Indian J Dermatol Venereol Leprol. 2016;82(3):292-7.
• Tan JKL, Li Y, Fung K, Gupta AK, Thomas DR, Sapra S, et al. Divergence of demographic factors associated with clinical severity compared with quality of life ımpact in acne. J Cutan Med Surg. 2008;12(5):235-42.
• Skroza N, Tolino E, Mambrin A, Zuber S, Balduzzi V, Marchesiello A, et al. Adult acne versus adolescent acne: A retrospective study of 1,167 patients. J Clin Aesthetic Dermatol. 2018;11(1):21-5.
• Stathakis V, Kilkenny M, Marks R. Descriptive epidemiology of acne vulgaris in the community. Australas J Dermatol. 1997;38(3):115-23.
• Jeremy AHT, Holland DB, Roberts SG, Thomson KF, Cunliffe WJ. Inflammatory events are involved in acne lesion initiation. J Invest Dermatol. 2003;121(1):20-7.
• Layton AM, Morris C, Cunliffe WJ, Ingham E. Immunohistochemical investigation of evolving inflammation in lesions of acne vulgaris. Exp Dermatol. 1998;7(4):191-7.
• Torun A, Çakırca TD, Çakırca G, Portakal RD. The value of C-reactive protein/albumin, fibrinogen/albumin, and neutrophil/lymphocyte ratios in predicting the severity of CoVID-19. Rev Assoc Médica Bras. 2021;67(3):431-6.
• Onder ENA, Ertan P. Fibrinogen-to-albumin ratio in Familial Mediterranean Fever: Association with subclinical inflammation. Klin Pädiatr. 2021;233(6):292-8.
• Wu W, Liu X, Zhu Q, Chen X, Sheng B, Zhang J, et al. The d-dimer/albumin ratio is a prognostic marker for aneurysmal subarachnoid hemorrhage. Brain Sci. 2022;12(12):1700.
• Olson JD. D-dimer. In: Advances in Clinical Chemistry [Internet]. Elsevier; 2015 [cited 2023 Jun 21]. p. 1-46. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0065242314000407
• Esposito K, Giugliano D. The metabolic syndrome and inflammation: Association or causation? Nutr Metab Cardiovasc Dis. 2004;14(5):228-32.
• Padhi T, Garima. Metabolic syndrome and skin: Psoriasis and beyond. Indian J Dermatol. 2013;58(4):299.
• Chandak S, Singh A, Madke B, Jawade S, Khandelwal R. Acne vulgaris and metabolic syndrome: A possible association. Cureus. 2022;14(5):e24750.
• Kimura Y, Tsukui D, Kono H. Uric acid in inflammation and the pathogenesis of atherosclerosis. Int J Mol Sci. 2021;22(22):12394.
• Yazdi F, Baghaei MH, Baniasad A, Naghibzadeh-Tahami A, Najafipour H, Gozashti MH. Investigating the relationship between serum uric acid to high-density lipoprotein ratio and metabolic syndrome. Endocrinol Diabetes Metab. 2022;5(1):e00311.
• Hasamoh Y, Thadanipon K, Juntongjin P. Association between vitamin D level and acne, and correlation with disease severity: A meta-analysis. Dermatology. 2022;238(3):404-11.
• Namazi M, Parhizkar A, Jowkar F. Serum levels of hypersensitive-C-reactive protein in moderate and severe acne. Indian Dermatol Online J. 2015;6(4):253-7.
• El-Taweel A, Salem R, El-Shimi O, Bayomy HEA, Mohamed S. Type I and type II acute-phase proteins in acne vulgaris. J Egypt Womens Dermatol Soc. 2019;16(1):31-6.