1
|
Esen M. Effect of isotretinoin treatment on inflammatory and hematological parameters in patients with acne vulgaris. Cutan Ocul Toxicol 2024; 43:27-32. [PMID: 37837334 DOI: 10.1080/15569527.2023.2268166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/23/2023] [Indexed: 10/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Mustafa Esen
- Department of Dermatological and Venereal Diseases, Fırat University Faculty of Medicine, Elazığ
| |
Collapse
|
2
|
Demirci Saadet E, Sahin U. Evaluation of hematological parameters in patients using systemic isotretinoin with diagnosis of acne vulgaris. J Cosmet Dermatol 2023; 22:1077-1082. [PMID: 36437707 DOI: 10.1111/jocd.15532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Elif Demirci Saadet
- Department of Dermatology, Atilim University, School of Medicine, Medicana International Ankara Hospital, Ankara, Turkey
| | - Ugur Sahin
- Department of Hematology, Atilim University, Vocational School of Health Services, Medicana International Ankara Hospital, Ankara, Turkey
| |
Collapse
|
3
|
Turan Ç, Coşansu NC, Yüksekal G. The SII reflects inflammation in acne vulgaris, but fails to determine categorical severity. J Cosmet Dermatol 2022; 21:6385-6392. [PMID: 35950891 DOI: 10.1111/jocd.15301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/02/2022] [Accepted: 07/26/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Systemic Immune Inflammation Index (SII; calculated by multiplying neutrophil-lymphocyte ratio and platelet count) has been investigated as a marker of inflammation. AIM we aimed to investigate the relationship of SII with acne severity and whether it can be used as a practical method in determining categorical acne severity. MATERIALS AND METHODS All participants (aged 15-30 years, n = 212) were prospectively evaluated with acne severity scales, including the Global Acne-Grading System (GAGS), the Comprehensive Acne Severity Scale (CASS), and the Patient-centered Acne Severity Scale. Patients were grouped according to GAGS: healthy individuals (n = 53), patients with mild (n = 44), moderate (n = 86), and severe acne (n = 29). Patients' hemogram data obtained simultaneously with the physical examination were used in the analysis. RESULTS The groups were statistically similar in terms of age and gender, both according to acne severity and current lesion types. The neutrophil count was significantly higher in patients with nodulocystic acne than in acne patients with non-inflammatory lesions or healthy individuals (p: 0.022). SII was significantly higher in acne patients with nodulocystic lesions than in individuals with milder lesions, both non-inflammatory and inflammatory (p = 0.004). SII was weakly significantly correlated with GAGS, CASS, and the number of nodulocystic lesions (r = 0.164, p = 0.018; r = 0.147, p = 0.034; r = 0.222, p = 0.001). However, none of the hemogram parameters, including SII, differed in classifying acne severity according to GAGS (p > 0.05). CONCLUSIONS Systemic immune inflammation index may be a new and reliable inflammatory marker to reflect the severity of inflammation, especially in patients with nodulocystic acne, although it is not useful in categorizing acne severity.
Collapse
Affiliation(s)
- Çağrı Turan
- Department of Dermatology and Venereology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Nur Cihan Coşansu
- Department of Dermatology, Education and Research Hospital, Sakarya University, Sakarya, Turkey
| | - Gülcan Yüksekal
- Department of Dermatology and Venereology, Yenikent State Hospital, Sakarya, Turkey
| |
Collapse
|
4
|
Hareedy MS, Tawfik KM. Systemic isotretinoin has an impact on hemoglobin, ferritin, urea, ceruloplasmin, albumin, uric acid levels, and neutrophil to lymphocyte ratio in acne patients. J Cosmet Dermatol 2022; 21:6191-6198. [PMID: 35770307 DOI: 10.1111/jocd.15199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/08/2022] [Accepted: 06/27/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Patients suffering from moderate-to-severe acne are commonly treated with systemin isotretinoin; however, a great controverse about its safety had been raised. The aim of the present study is to evaluate the effects of isotretinoin on hepatic, renal, and hematologic functions and to evaluate the potential oxidative stress in relation to isotretinoin therapy. METHODS Fifty-three female patients, treated from moderate-severe acne with isotretinoin (0.5 mg/kg/day), were included. Blood samples were taken for measuring low density lipoprotein (LDL), triglycerides, hemoglobin, erythrocyte sedimentation rate (ESR), bilirubin, total protein, albumin, globulin, blood urea nitrogen, ferritin, uric acid, creatinine, C-reactive protein (CRP), ceruloplasmin, alanine transaminase (ALT), aspartate transaminase (AST) levels, and red blood cells (RBC), white blood cells (WBCs), and platelet counts before starting isotretinoin treatment and 6 months later. RESULTS Isotretinoin was associated with increased levels of triglycerides, LDL, ESR, CRP, uric acid, and ferritin after 6 months of therapy (p < 0.0001), blood urea levels were significantly elevated from 3.681 ± 0.91 to 3.838 ± 0.877 (p = 0.014), ALT, AST, hemoglobin, globulin, and total proteins were significantly elevated after 6 months. Platelets, WBCs, albumin, albumin/globulin ratio, copper, ceruloplasmin, and neutrophil/lymphocyte ratio were significantly decreased after 6 months. CONCLUSION Isotretinoin therapy could be associated with oxidative stress and hepatic, lipid, and blood abnormalities in patients with acne. Serum ferritin was elevated while serum ceruloplasmin was decreased. Isotretinoin could also affect immune regulation (decreasing neutrophil to lymphocyte ratio), isotretinoin was associated with a possible positive nitrogen balance (increasing proteins) and with elevations of blood urea nitrogen and uric acid levels.
Collapse
Affiliation(s)
| | - Khaled Mohamed Tawfik
- Department of Dermatology and Andrology, Al-Azhar University (Assuit), Assiut, Egypt
| |
Collapse
|
5
|
High Neutrophil-to-Lymphocyte Ratio Facilitates Cancer Growth-Currently Marketed Drugs Tadalafil, Isotretinoin, Colchicine, and Omega-3 to Reduce It: The TICO Regimen. Cancers (Basel) 2022; 14:cancers14194965. [PMID: 36230888 PMCID: PMC9564173 DOI: 10.3390/cancers14194965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/03/2022] [Accepted: 10/03/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Several elements that are composed of, or related to, neutrophils, have been shown to inhibit strong immune responses to cancer and promote cancers’ growth. This paper presents the collected data showing these elements and how their coordinated actions as an ensemble facilitate growth in the common cancers. The paper goes on to present a drug regimen, TICO, designed to reduce the cancer growth enhancing effects of the neutrophil related elements. TICO uses four already marketed, readily available generic drugs, repurposed to inhibit neutrophil centered growth facilitation of cancer. Abstract This paper presents remarkably uniform data showing that higher NLR is a robust prognostic indicator of shorter overall survival across the common metastatic cancers. Myeloid derived suppressor cells, the NLRP3 inflammasome, neutrophil extracellular traps, and absolute neutrophil count tend to all be directly related to the NLR. They, individually and as an ensemble, contribute to cancer growth and metastasis. The multidrug regimen presented in this paper, TICO, was designed to decrease the NLR with potential to also reduce the other neutrophil related elements favoring malignant growth. TICO is comprised of already marketed generic drugs: the phosphodiesterase 5 inhibitor tadalafil, used to treat inadequate erections; isotretinoin, the retinoid used for acne treatment; colchicine, a standard gout (podagra) treatment; and the common fish oil supplement omega-3 polyunsaturated fatty acids. These individually impose low side effect burdens. The drugs of TICO are old, cheap, well known, and available worldwide. They all have evidence of lowering the NLR or the growth contributing elements related to the NLR when clinically used in general medicine as reviewed in this paper.
Collapse
|
6
|
Cosansu NC, Yuksekal G, Turan U, Umitfer F, Yaldiz M, Sevimli Dikicier B. 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. Cutan Ocul Toxicol 2022; 41:174-178. [PMID: 35658795 DOI: 10.1080/15569527.2022.2081700] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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.
Collapse
Affiliation(s)
- Nur Cihan Cosansu
- Education and Research Hospital, Sakarya University, Sakarya, Turkey
| | - Gülcan Yuksekal
- Department of Dermatology, Yenikent State Hospital, Sakarya, Turkey
| | - Ulku Turan
- Education and Research Hospital, Sakarya University, Sakarya, Turkey
| | - Fulya Umitfer
- Education and Research Hospital, Sakarya University, Sakarya, Turkey
| | - Mahizer Yaldiz
- Education and Research Hospital, Sakarya University, Sakarya, Turkey
| | | |
Collapse
|
7
|
A Novel Inflammatory Marker in the Follow-up of Moderate-to-Severe Acne Vulgaris Administered Isotretinoin: Systemic Immune-Inflammation Index (SII). CURRENT HEALTH SCIENCES JOURNAL 2022; 48:63-67. [PMID: 35911945 PMCID: PMC9289579 DOI: 10.12865/chsj.48.01.09] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Systemic immune-inflammation index (SII) is calculated by multiplying the neutrophil-lymphocyte ratio (NLR) and the platelet count. In this study, we aimed to investigate the difference of SII and other inflammatory markers in patients with acne vulgaris compared to healthy controls and themselves after Oral isotretinoin (ISO) treatment. MATERIALS AND METHODS In this study 190 patients with severe acne vulgaris who received at least 3 months of ISO treatment (0.5-1mg/kg/day) and 66 healthy individuals were evaluated. Hemoglobin, neutrophil, lymphocyte, monocyte, and platelet counts, mean platelet volume (MPV), Plateletcrit (PCT), NLR, platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and SII were analyzed. RESULTS Before ISO treatment, patients with moderate-to-severe acne vulgaris had significantly higher neutrophil counts and SII levels than healthy controls (p=0.036, p=0.028; respectively). In the third month of ISO treatment, both neutrophil count and SII level were similar to healthy control (p=0.376, p=0.379; respectively). In the follow-up of patients using ISO, a significant decrease was observed especially in SII levels (p=0.037). Although the lymphocyte count was not significantly different from the control group before treatment, it increased significantly after ISO and was significantly higher than both the control and pretreatment period (p=0.134, P=0.026, p=0.017; respectively). Although NLR was not different from control in the pre- and post-treatment period, the change in neutrophil and lymphocyte counts after treatment caused a statistically significant decrease in NLR (p=0.682, p=0.289, p=0.043; respectively). CONCLUSIONS We believe that SII is a more useful parameter as an indicator of the anti-inflammatory effect of isotretinoin.
Collapse
|