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Sistemik İsotretionin Tedavisi Alan Akne Vulgarisli Hastalarda Hematolojik ve İnflamatuar Parametrelerin Değerlendirilmesi

Yıl 2018, Cilt: 9 Sayı: 34, 61 - 67, 01.09.2018
https://doi.org/10.17944/mkutfd.421437

Öz

Amaç: İsotretinoin sentetik vitamin A analoğudur. Orta ve şiddetli akne vulgariste 0.5-2mg/kg /gün dozunda 4-5 ay süreyle kullanılır. Bu çalışmada oral isotretinoin tedavisi alan akne vulgarisli hastalarda hematolojik ve inflamatuar parametrelerin retrospektif olarak değerlendirilmesi amaçlanmıştır.

Metot: Çalışmaya dermatoloji polikliniğine başvuran ve akne vulgaris tanısıyla oral isotretinoin tedavisi başlanan 352 hasta alındı. Hastaların tedavi öncesi ve tedavi başlangıcından 4 ay son-raki hematolojik ve inflamatuar parametreleri (hemoglobin, hematokrit, trombosit, ortalama trombosit hacmi, lökosit, eritrosit, nötrofil, lenfosit, monosit, eozinofil, bazofil, nötrofil /bazofil, trombosit/lenfosit, RDW, PCT, PDW) retrospektif olarak incelendi.

Bulgular: Tedaviden sonra lökosit, nötrofil ve nötrofil lenfosit oranına (NLO) seviye-lerinde istatistiksel olarak anlamlı bir azalma saptandı. Trombosit ve prokalsitonin (PCT) düzeylerinde istatistiksel olarak anlamlı bir artış saptandı.

Sonuç: Çalışmamızda saptadığımız isotreinoin tedavi sonrası inflamatuar belirteçlerinden NLR düşme akne de isotretinoin tedavisinin antienflamatuar etkisini desteklemektedir. Belirgin olarak trombosit yuksekliği olan veya lökosit düşüklüğü olan hastalarda yakın takip edilmelidir.

Kaynakça

  • Degitz K, Placzek M, Borelli C, Plewig G. Pathophysiology of acne. J Dtsch Dermatol Ges.2007;5:316-23.
  • Jones H, Blanc D, Cunliffe WJ. 13-cis retinoic acid and acne. Lancet 1980; 2: 1048–9.
  • Boyraz N, Mustak PK. Comparison of the efficacies of intermittent and continuous low-dose isotretinoin regimensin the treatment of moderate acne vulgaris. Int J Dermatol.2013;52:1265-7.
  • Michaëlsson G, Vahlquist A, Mobacken H, Hersle K, Landegren J, Rönnerfält L, et al. Changes in laboratory variables induced by isotretinoin treatment of acne. Acta Derm Venereol 1986; 66: 144–8.
  • Moeller KE, Touma SC. Prolonged thrombocytopenia associated with isotretinoin. AnnPharmacother 2003;37:1622–4.
  • Friedman SJ. Leukopenia and neutropeniaassociated with isotretinoin therapy. Arch Dermatol 1987; 123: 293-5.
  • Jansen T, Altmeyer P. Thrombocytosis induced by low-doseisotretinoin. Int J Dermatol 2000; 39: 956-7.
  • Sen BB, Rifaioglu EN, Ekiz O, Inan MU, Sen T, Sen N. Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. Cutan Ocul Toxicol 2014; 33: 223-7.
  • Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012;26:5(1):2.
  • Wang GY, Yang Y, Li H, Zhang J, Jiang N, Li MR, Zhu HB, Zhang Q, Chen GH. A scoring model based on neutrophil to lymphocyte ratio predicts recurrence of HBV-associated hepatocellular carcinoma after liver transplantation. PLoS One 2011;6: e25295.
  • Kaya A, Kurt M, Tanboga IH, Işık T, Günaydın ZY, Kaya Y, et al. Relation of neutrophil-to-lymphocyte ratio with the presence and severity of stable coronary artery disease. Clin Appl Thromb Hemost 2014; 20: 473-7.
  • Endler G, Klimesch A, Sunder-Plassmann H, Schillinger M, Exner M, Mannhalter C, et al. Mean platelet volume is an independent risk factor for myocardial infarction but not for coronary artery disease. Br J Haematol 2002; 117: 399–404.
  • Canpolat F,Akpınar H, Eskioğlu F. Mean platelet volume in psoriasis and psoriatic arthritis. Clin Rheumatol 2010; 29: 325-8.
  • Hensen G, Schiller M, Luger TA, Hensen P. Psychosocial issues in outpatient care of acnevulgaris. Gesundheitswesen 2009; 71(7):405-13.
  • Farrell LN, Strauss JS, Stranieri AM. The treatment of severe cystic acne with 13-cisretinoic acid. Evaluation of sebum production and the clinical response in a multipledose trial. J Am Acad Dermatol 1980; 3: 602–11.
  • Ertam I, Alper S, Unal I. Is it necessary to have routine blood tests inpatients treatedwith isotretinoin? J Dermatolog Treat 2006; 17: 214–6.
  • Charakida A, Mouser PE, Chu AC. Safety and side effects of the acne drug, oral isotretinoin. Expert Opin Drug Saf 2004; 3: 119-29.
  • Karadag AS, Ertugrul DT, Takci Z. Isotretinoin modestly increases platelet count in acne patients. J Dermatolog Treat. 2013; 24: 139-40.
  • Bruno NP, Beacham BE, Burnett JW. Adverse effects of isotretinoin therapy. Cutis. 1984; 33:484.
  • Schmutz JL, Barbaud A, Trechot P. Thrombocytosis induced by low-dose isotretinoin (Roaccutane(R)).Ann Dermatol Venereol 2002; 129: 35516.
  • JohnsonTM, Rapini RP. Isotretinoin-induced thrombocytopenia. J Am Acad Dermatol. 1987; 17: 838-9.
  • Hesdorffer CS, Weltman MD, Raftopoulos H. Thrombocytopenia caused by isotretinoin. S Afr Med J. 1986; 70: 705-6.
  • Gold EJ, Mertelsmann RH, Itri LM, Gee T, Arlin Z, Kempin S, et al. Phase I clinical trial of 13-cis-retinoic acid in myelodysplastic syndromes. Cancer Treat Rep. 1983;67: 981–6.
  • Yu C, Liu Y, Miao Z, Yin M, Lu W, Lv Y, et al. Retinoic acid enhances the generation of hematopoietic progenitors from human embryonic stem cell-derived hemato-vascular precursors. Blood 2010;116: 4786–94.
  • Schweinfurth N, Hohmann S, Deuschle M, Lederbogen F, Schloss P. Valproic acid and all trans retinoic acid differentially induce megakaryopoiesis and platelet-like particle formation from the megakaryoblastic cell line MEG-01. Platelets 2010; 21: 648–57.
  • Ozdemir MA, Kose M, Karakukcu M. Isotretinoin induced a granulocytosis. PediatrDermatol 2007; 24: 425-6.
  • Zane LT, Leyden WA, Marqueling AL, Manos MM. A population-based analysis of laboratory abnormalities during isotretinoin therapy for acne vulgaris. Arch Dermatol 2006; 142: 1016-22.
  • Karadag AS, Ertugrul DT, Bilgili SG, Takci Z, Akin KO, Calka O. Immunoregulatory effects of isotretinoin in patients with acne. Br J Dermatol 2012; 167: 433–5.
  • Kuyumcu ME, Yesil Y, Oztürk ZA, Kizilarslanoğlu C, Etgül S, Halil M, et al. The evaluation of neutrophil–lymphocyte ratio in Alzheimer’s disease. Dement Geriatr Cogn Disord 2012; 34: 69–74.
  • Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol 2012; 36: 491–7.
  • Balta I, Balta S, Demirkol S, Ozturk C, Celik T. Neutrophil-to-lymphocyte ratio may predict subclinical atherosclerosis in patients with psoriasis. Echocardiography 2014; 31:1166–7.
  • Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009; 133: 628–32
  • Seckin HY, Baş Y, Takçı Z, Kalkan G. Effects of isotretinoin on the inflammatory markers and the platelet counts in patients with acne vulgaris. Cutan Ocul Toxicol 2016:1-3.

Assessment of Hematological and Inflammatory Parameters in Patients Receiving Isotretinoin Therapy for Acne Vulgaris

Yıl 2018, Cilt: 9 Sayı: 34, 61 - 67, 01.09.2018
https://doi.org/10.17944/mkutfd.421437

Öz

Objectives:Isotretinoin (ISO) is a synthetic analog of vitamin A used at the doses of 0.5–2 mg/kg for four to five months in the treatment of moderate to severe acne vulgaris. In the present study, both hematological and inflammatory parameters were retrospectively assessed in patients receiving ISO therapy for acne vulgaris.

Method: This study included 352 patients who were admitted to the Dermatology Clinic and received oral ISO for the treatment of acne vulgaris were included in the study. Each patient’s hematological and inflammatory parameters (hemoglobin, hematocrit, thrombocyte, mean platelet volume, leukocyte, erythrocyte, neutrophil, lymphocyte, monocyte, eosinophil, basophil, neutrophil/basophil, thrombocyte/lymphocyte, RDW, PCT and PDW) were evaluated before the treatment and retrospectively evaluated four months after the onset of treatment. 

Results: After treatment, a significant decrease was detected in the levels of leukocyte, neutrophil and neutrophil to lymphocyte ratio (NLR) (an indicator of inflammation), and a significant increase was detected in the levels of thrombocyte and procalcitonin (PCT).

Conclusion: In our study, isotretinoin inhibited the anti-inflammatory effect of isotretinoin treatment of acne in patients with NLR decline after treatment with inflammatory markers. Patients with markedly elevated platelet counts or low leukocyte counts should be closely monitored.

Kaynakça

  • Degitz K, Placzek M, Borelli C, Plewig G. Pathophysiology of acne. J Dtsch Dermatol Ges.2007;5:316-23.
  • Jones H, Blanc D, Cunliffe WJ. 13-cis retinoic acid and acne. Lancet 1980; 2: 1048–9.
  • Boyraz N, Mustak PK. Comparison of the efficacies of intermittent and continuous low-dose isotretinoin regimensin the treatment of moderate acne vulgaris. Int J Dermatol.2013;52:1265-7.
  • Michaëlsson G, Vahlquist A, Mobacken H, Hersle K, Landegren J, Rönnerfält L, et al. Changes in laboratory variables induced by isotretinoin treatment of acne. Acta Derm Venereol 1986; 66: 144–8.
  • Moeller KE, Touma SC. Prolonged thrombocytopenia associated with isotretinoin. AnnPharmacother 2003;37:1622–4.
  • Friedman SJ. Leukopenia and neutropeniaassociated with isotretinoin therapy. Arch Dermatol 1987; 123: 293-5.
  • Jansen T, Altmeyer P. Thrombocytosis induced by low-doseisotretinoin. Int J Dermatol 2000; 39: 956-7.
  • Sen BB, Rifaioglu EN, Ekiz O, Inan MU, Sen T, Sen N. Neutrophil to lymphocyte ratio as a measure of systemic inflammation in psoriasis. Cutan Ocul Toxicol 2014; 33: 223-7.
  • Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012;26:5(1):2.
  • Wang GY, Yang Y, Li H, Zhang J, Jiang N, Li MR, Zhu HB, Zhang Q, Chen GH. A scoring model based on neutrophil to lymphocyte ratio predicts recurrence of HBV-associated hepatocellular carcinoma after liver transplantation. PLoS One 2011;6: e25295.
  • Kaya A, Kurt M, Tanboga IH, Işık T, Günaydın ZY, Kaya Y, et al. Relation of neutrophil-to-lymphocyte ratio with the presence and severity of stable coronary artery disease. Clin Appl Thromb Hemost 2014; 20: 473-7.
  • Endler G, Klimesch A, Sunder-Plassmann H, Schillinger M, Exner M, Mannhalter C, et al. Mean platelet volume is an independent risk factor for myocardial infarction but not for coronary artery disease. Br J Haematol 2002; 117: 399–404.
  • Canpolat F,Akpınar H, Eskioğlu F. Mean platelet volume in psoriasis and psoriatic arthritis. Clin Rheumatol 2010; 29: 325-8.
  • Hensen G, Schiller M, Luger TA, Hensen P. Psychosocial issues in outpatient care of acnevulgaris. Gesundheitswesen 2009; 71(7):405-13.
  • Farrell LN, Strauss JS, Stranieri AM. The treatment of severe cystic acne with 13-cisretinoic acid. Evaluation of sebum production and the clinical response in a multipledose trial. J Am Acad Dermatol 1980; 3: 602–11.
  • Ertam I, Alper S, Unal I. Is it necessary to have routine blood tests inpatients treatedwith isotretinoin? J Dermatolog Treat 2006; 17: 214–6.
  • Charakida A, Mouser PE, Chu AC. Safety and side effects of the acne drug, oral isotretinoin. Expert Opin Drug Saf 2004; 3: 119-29.
  • Karadag AS, Ertugrul DT, Takci Z. Isotretinoin modestly increases platelet count in acne patients. J Dermatolog Treat. 2013; 24: 139-40.
  • Bruno NP, Beacham BE, Burnett JW. Adverse effects of isotretinoin therapy. Cutis. 1984; 33:484.
  • Schmutz JL, Barbaud A, Trechot P. Thrombocytosis induced by low-dose isotretinoin (Roaccutane(R)).Ann Dermatol Venereol 2002; 129: 35516.
  • JohnsonTM, Rapini RP. Isotretinoin-induced thrombocytopenia. J Am Acad Dermatol. 1987; 17: 838-9.
  • Hesdorffer CS, Weltman MD, Raftopoulos H. Thrombocytopenia caused by isotretinoin. S Afr Med J. 1986; 70: 705-6.
  • Gold EJ, Mertelsmann RH, Itri LM, Gee T, Arlin Z, Kempin S, et al. Phase I clinical trial of 13-cis-retinoic acid in myelodysplastic syndromes. Cancer Treat Rep. 1983;67: 981–6.
  • Yu C, Liu Y, Miao Z, Yin M, Lu W, Lv Y, et al. Retinoic acid enhances the generation of hematopoietic progenitors from human embryonic stem cell-derived hemato-vascular precursors. Blood 2010;116: 4786–94.
  • Schweinfurth N, Hohmann S, Deuschle M, Lederbogen F, Schloss P. Valproic acid and all trans retinoic acid differentially induce megakaryopoiesis and platelet-like particle formation from the megakaryoblastic cell line MEG-01. Platelets 2010; 21: 648–57.
  • Ozdemir MA, Kose M, Karakukcu M. Isotretinoin induced a granulocytosis. PediatrDermatol 2007; 24: 425-6.
  • Zane LT, Leyden WA, Marqueling AL, Manos MM. A population-based analysis of laboratory abnormalities during isotretinoin therapy for acne vulgaris. Arch Dermatol 2006; 142: 1016-22.
  • Karadag AS, Ertugrul DT, Bilgili SG, Takci Z, Akin KO, Calka O. Immunoregulatory effects of isotretinoin in patients with acne. Br J Dermatol 2012; 167: 433–5.
  • Kuyumcu ME, Yesil Y, Oztürk ZA, Kizilarslanoğlu C, Etgül S, Halil M, et al. The evaluation of neutrophil–lymphocyte ratio in Alzheimer’s disease. Dement Geriatr Cogn Disord 2012; 34: 69–74.
  • Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol 2012; 36: 491–7.
  • Balta I, Balta S, Demirkol S, Ozturk C, Celik T. Neutrophil-to-lymphocyte ratio may predict subclinical atherosclerosis in patients with psoriasis. Echocardiography 2014; 31:1166–7.
  • Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009; 133: 628–32
  • Seckin HY, Baş Y, Takçı Z, Kalkan G. Effects of isotretinoin on the inflammatory markers and the platelet counts in patients with acne vulgaris. Cutan Ocul Toxicol 2016:1-3.
Toplam 33 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Original Articles
Yazarlar

Mahizer Yaldız

Reyhan Çetinkaya Bu kişi benim

Berna Solak Bu kişi benim

Yayımlanma Tarihi 1 Eylül 2018
Gönderilme Tarihi 6 Mayıs 2018
Kabul Tarihi 14 Aralık 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 9 Sayı: 34

Kaynak Göster

Vancouver Yaldız M, Çetinkaya R, Solak B. Assessment of Hematological and Inflammatory Parameters in Patients Receiving Isotretinoin Therapy for Acne Vulgaris. mkutfd. 2018;9(34):61-7.