Can monocyte/HDL show inflammatory activity of isotretinoin treatment in acne patients?

Correlation between depression scores and serum NF-ĸB/NLRP3 axis, biotinidase, and HMGB1 after treatment with isotretinoin in patients with acne vulgaris

BACKGROUND

Acne vulgaris (AV) is an inflammatory skin disorder leading to scars and discomfort, its intensity has major psychological consequences such as depression.

AIM

To investigate the effect of isotretinoin (ISO) on NF-κB/NLRP3, biotinidase, and HMGB and correlation with depression.

PATIENTS AND METHODS

This was a case-control study that involved two groups. Group 1 is 20 healthy control, and group 2 is 20 patients diagnosed with AV according to Global Acne Grading System (GAGS) and received 20 mg ISO for 2 months. Before and after therapy, the Hamilton Depression Rating Scale (HDRS) was applied to assess each participant's level of depression. Nuclear factor kappa B (NF-ĸB), biotinidase, high mobility group box protein (HMGB1), nucleotide-binding domain, leucine-rich-containing family, and pyrin domain-containing-3 (NLRP-3) were measured in serum samples.

RESULTS

There was no significant difference in all measured markers of healthy group before and after 2 months. Regarding group 2, there was a statistically significant decrease in all measured markers after 2 months of treatment and significant correlations between GAGS, NF-ĸB, HMGB1, NLRP3, biotinidase, and depression score.

CONCLUSION

Increased GAGS, HMGB1, NLRP3, and biotinidase were associated with depression severity in AV patients and ISO treatment significantly reduced these parameters and reduced depressive symptoms.

Effect of isotretinoin treatment on inflammatory and hematological parameters in patients with acne vulgaris

PURPOSE

Although the inflammatory and anti-inflammatory effects of isotretinoin (ISO) treatment in patients with acne vulgaris have been discussed in the literature in recent years, no sensitive and specific marker has been found in studies so far. Neutrophil/HDL (high-density lipoprotein) (NHR), lymphocyte/HD L(LHR), platelet/HDL (PHR), and lymphocyte/monocyte (LMR) are new biomarkers related to inflammation. Triglyceride/HDL (TG/HDL), LDL/HDL, and total cholesterol/HDL have been shown to be cardiometabolic risk factors predicting both cardiovascular disease risk and metabolic risk, rather than just a simple dyslipidemia scale. To our knowledge, the relationship between these parameters and ISO treatment has never been studied before. We aimed to evaluate the immuno-inflammatory response of ISO treatment in patients with acne vulgaris with NHR, LHR, PHR, LMR, TG/HDL, LDL/HDL, and total cholesterol/HDL parameters.

MATERIALS AND METHODS

In this study, 153 patients who received oral ISO treatment for at least 3 months with a diagnosis of moderate-severe acne vulgaris were evaluated retrospectively. Patients were given oral isotretinoin at a dose of 0.5-1 mg/kg. Pre and post-treatment leukocyte (WBC), neutrophil (NE), lymphocyte (LY), platelet (PLT), red cell distribution width (RDW), plateletcrit (PCT), neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), mean platelet volume (MPV), monocyte/lymphocyte (MLR), LMR, total cholesterol, LDL cholesterol, HDL cholesterol, triglyceride, MHR, NHR, LHR, PHR, TG/HDL, total cholesterol/HDL, LDL/HDL parameters were evaluated.

RESULTS

It was found that post-treatment WBC and MPV values increased statistically significantly; NLR, neutrophil, and PCT values, on the other hand, decreased significantly (p < 0.05). No statistically significant change was detected in PLR, MLR, LMR, MHR, NHR, LHR, PHR, lymphocyte, monocyte, platelet, and RDW parameters (p > 0.05). It was determined that post-treatment total cholesterol, triglyceride, VLDL, and LDL levels increased statistically significantly; however, the HDL level decreased significantly (p < 0.05). Levels of total cholesterol/HDL, TG/HDL, and LDL/HDL were also found to increase statistically significantly (p < 0.05).

CONCLUSION

Our study suggests that the MPV and NLR ratio as biomarkers can be used as indicators of atherosclerosis-related inflammation due to ISO treatment, but the MHR, NHR, LHR, PHR, MLR, LMR ratios cannot be used. Moreover, we believe that the ratios of TG/HDL, LDL/HDL, and total cholesterol/HDL offer a new contribution as indicators of cardiovascular risk and systemic inflammation related to ISO treatment.

Evaluation of hematological parameters in patients using systemic isotretinoin with diagnosis of acne vulgaris

OBJECTIVES

Oral isotretinoin is the most effective treatment option in patients with acne. However, it can cause various hematologic and biochemical abnormalities. This study aimed to evaluate hematologic abnormalities during oral isotretinoin treatment in patients with acne.

MATERIAL AND METHODS

In this cross-sectional study, the hematologic and inflammatory parameters of 138 patients with acne using 0.3-1 mg/kg/day oral isotretinoin for at least 6 months were retrospectively analyzed.

RESULTS

In the study, the female-to-male ratio was 2.83, and the mean age of the patients was 23.1 ± 5.8 years. At the third and sixth months of isotretinoin treatment, there was a statistically significant decrease in the neutrophil count compared to the pre-treatment values (p = 0.003 and p = 0.032, respectively). The platelet count showed the most statistically significant increase (p < 0.001) at the first month of treatment. The most statistically significant decrease in the neutrophil-to-lymphocyte ratio (NLR) was observed at the third month of treatment (p < 0.001). No significant changes were observed in hemoglobin, hematocrit, white blood cell count, mean corpuscular volume, and mean platelet volume.

CONCLUSIONS

There was a decrease in neutrophils and NLR and an increase in platelets during isotretinoin treatment, and these changes were usually mild. However, it would be appropriate to monitor blood counts during treatment in patients with neutropenia or thrombocytosis.

Investigation of systemic immune-inflammation index and systemic inflammation response index as an indicator of the anti-inflammatuary effect of isotretinoin in patients with acne vulgaris

PURPOSE

Oral isotretinoin (ISO) can effect markers of inflammation in patients with acne vulgaris. Systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) were described as novel inflammatory and prognostic biomarkers. The present study aimed to evaluate the effectiveness of SII, SIRI, and other inflammatory markers in patients with acne vulgaris who receive isotretinoin therapy.

METHODS

One hundred fifty-six patients with moderate-to-severe acne vulgaris who received at least 3 months of ISO treatment (0.5-1 mg/kg/day) and 100 healthy individuals were enrolled in the study. The medical records and laboratory findings of the participants were reviewed retrospectively. Pre-treatment and post-treatment neutrophil, lymphocyte, monocyte, and platelet counts, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), SII, SIRI, total cholesterol, LDL cholesterol, triglyceride, HDL cholesterol, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were analysed.

RESULTS

Before ISO treatment, patients with moderate-to-severe acne vulgaris had significantly higher platelet counts than healthy controls (p = 0.003). Serum total cholesterol, LDL, triglyceride, AST, and ALT increased significantly after isotretinoin treatment in patients with acne vulgaris (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p = 0.029, respectively). In the follow-up of patients using ISO, a significant increase was found in platelet levels (p < 0.001). However, neutrophil, NLR, SII, and SIRI were found significantly decrease after ISO treatment (p = 0.047, p = 0.038, p = 0.003, p = 0.001; respectively). Lymphocyte, monocyte, PLR, and MLR did not show any significant change after ISO treatment.

CONCLUSION

SII and SIRI are better parameters as an indicator of the anti-inflammatory effect of isotretinoin than other inflammatory markers.

Increases in uric acid and monocyte-high-density lipoprotein ratio as possible atherosclerotic indicators in acne patients using isotretinoin

PURPOSE

We aimed to reveal the relationship of serum uric acid (SUA) with monocyte-high-density lipoprotein ratio (MHR) and other inflammatory markers in acne patients before and after isotretinoin treatment. In this way, we can try to shed light on the relationship between isotretinoin treatment and atherosclerosis.

METHODS

Two hundred twenty-four acne patients who administered isotretinoin (0.5-1 mg/kg/day) were enrolled in the study. In the pretreatment phase and 3 months after treatment, MHR, SUA, mean platelet volume, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio, monocyte-lymphocyte ratio, serum triglyceride, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) levels of the patients were analyzed.

RESULTS

Compared to the pretreatment phase, three months after treatment, there was a statistically decrease in neutrophil count and an increase in lymphocyte count (p: 0.002, p: 0.011, respectively). Accordingly, there was a statistically significant decrease in NLR (p: 0.001). It was noteworthy that MHR and SUA levels increased significantly (p: 0.042, p: 0.010, respectively) and there was a positive correlation between SUA level and MHR (r: 0.212, p: 0.012). Serum total cholesterol, LDL, and triglyceride levels increased and HDL levels decreased significantly after treatment (p: 0.001).

CONCLUSION

This study contributes to the comprehension of the relationship between isotretinoin treatment and atherosclerosis, which has been frequently reported in the literature. It was thought that the isotretinoin-induced SUA increase might be related to dyslipidemia. Isotretinoin may initiate the atherosclerotic process in vascular endothelial and smooth muscles, with SUA increase and HDL decrease. An increase in MHR is also an inflammatory marker indicating this process.