1
|
Lu X, Han Y, Zhang Y, Li R, Xu J, Yang J, Yao J, Lv Z. An integrated network pharmacology and molecular docking approach to reveal the role of Arctigenin against Cutibacterium acnes-induced skin inflammation by targeting the CYP19A1. Chem Biol Drug Des 2024; 104:e14598. [PMID: 39090783 DOI: 10.1111/cbdd.14598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 06/06/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
Acne caused by inflammation of hair follicles and sebaceous glands is a common chronic skin disease. Arctigenin (ATG) is an extract of Arctium lappa L., which has significant anti-inflammatory effects. However, the effect and mechanism of ATG in cutaneous inflammation mediated by Cutibacterium acnes (C. acnes) has not been fully evaluated. The purpose of this study was to explore the effect and potential mechanism of ATG in the treatment of acne through network pharmacology and experimental confirmation. An acne model was established by injected live C. acnes into living mice and treated with ATG. Our data showed that ATG effectively improved acne induced by live C. acnes, which was confirmed by determining ear swelling rate, estradiol concentration and hematoxylin and eosin (H&E) staining. In addition, ATG inhibited the NLRP3 inflammasome signaling pathway in mice ear tissues and reduced the secretion of pro-inflammatory cytokines IL-1β to relieve inflammation. The results of network pharmacology and molecular docking confirmed that ATG can regulate 17β-Estradiol (E2) levels through targeted to CYP19A1, and finally inhibited skin inflammation. Taken together, our results confirmed that ATG regulated E2 secretion by targeting CYP19A1, thereby inhibiting the NLRP3 inflammasome signaling pathway and improving inflammation levels in acne mice. This study provides a basis for the feasibility of ATG in treating acne in clinical practice.
Collapse
Affiliation(s)
- Xiaoyan Lu
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Linyi, People's Republic of China
- National Engineering and Technology Research Center of Chirality Pharmaceutical, Linyi, People's Republic of China
| | - Yanzhong Han
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Linyi, People's Republic of China
- National Engineering and Technology Research Center of Chirality Pharmaceutical, Linyi, People's Republic of China
| | - Yongkang Zhang
- College of Pharmacy, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Rui Li
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Linyi, People's Republic of China
- National Engineering and Technology Research Center of Chirality Pharmaceutical, Linyi, People's Republic of China
| | - Jiaoyan Xu
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Linyi, People's Republic of China
- National Engineering and Technology Research Center of Chirality Pharmaceutical, Linyi, People's Republic of China
| | - Jian Yang
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Linyi, People's Republic of China
- National Engineering and Technology Research Center of Chirality Pharmaceutical, Linyi, People's Republic of China
| | - Jingchun Yao
- State Key Laboratory of Integration and Innovation of Classic Formula and Modern Chinese Medicine, Linyi, People's Republic of China
- National Engineering and Technology Research Center of Chirality Pharmaceutical, Linyi, People's Republic of China
| | - Zhihai Lv
- Longgang District Maternity and Child Healthcare Hospital of Shenzhen City, Shenzhen, People's Republic of China
| |
Collapse
|
2
|
AbdElneam AI, Alhajlah S, Al‐Dhubaibi MS, Bahaj SS, Mohammed GF, Alantry AK, Atef LM. In severe acne vulgaris, TNF-α gene variants are connected to increased TNF-α gene expression and insulin resistance. Skin Res Technol 2024; 30:e13811. [PMID: 38923681 PMCID: PMC11197027 DOI: 10.1111/srt.13811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Acne vulgaris (AV) is a chronic inflammatory skin condition affecting the pilosebaceous unit, commonly presenting as comedones, papules, pustules, or nodules on the face, upper limbs, torso, and back, with comedones formation being the primary pathology leading to disfiguring inflammation, hyperpigmentation, scarring, and psychological impact. AIM The purpose of this study was to investigate the significance of two genetic variants in the promoter region of the tumor necrosis factor-alpha (TNF-α) gene and their association with insulin resistance (IR) in acne patients. To understand how these variants contribute to AV and its associated IR. SUBJECTS AND METHODS An analytical cross-sectional study with a case-control design and research evaluation was carried out on 87 AV patients and 73 healthy volunteers. The medical histories of both groups were obtained, as well as the severity and duration of inflammation among acne sufferers, as well as demographic data. Biochemical analysis was performed on both sets of participants, including fasting blood glucose levels, insulin levels while fasting, IR, and serum TNF-α. PCR-RFLP analysis identified -863 G > A (rs1800630) and -308 G > A (rs1800629) variations, and real-time PCR analysis evaluated TNF-α gene expression in both patients and healthy people. RESULTS Acne patients exhibited significantly higher levels of IR, fasting glucose, fasting insulin, serum TNF-α, and TNF-α folding change, when compared to healthy controls. The co-dominant model for -863 G > A and -308 G > A variants exhibited significant variations between the two groups. Severe acne patients who had the A/A genotype for -308 variants exhibited higher levels of IR, serum TNF-α, and TNF-α folding change. Highly significant positive linear correlation between IR, serum TNF-α, and TNF-α folding change in severe AV. CONCLUSION There is a correlation between AV, especially severe acne, and the -863 G > A and -308 G > A polymorphism, which influences TNF-α gene expression and serum TNF-α levels.
Collapse
Affiliation(s)
- Ahmed Ibrahim AbdElneam
- Department of Clinical BiochemistryDepartment of Basic Medical SciencesCollege of MedicineShaqra UniversityDawadmiSaudi Arabia
- Molecular Genetics and Enzymology DepartmentHuman Genetics and Genome Research InstituteNational Research CenterDokkiCairoEgypt
| | - Sharif Alhajlah
- Department of Medical LaboratoriesCollege of Applied Medical SciencesShaqra UniversityShaqraSaudi Arabia
| | | | - Saleh Salem Bahaj
- Department of Microbiology and ImmunologyFaculty of Medicine and Health SciencesSana'a UniversitySana'aYemen
| | - Ghada Farouk Mohammed
- Department of Dermatology, Venereology, and SexologyFaculty of MedicineSuez Canal UniversityIsmailiaEgypt
| | - Ahmed Kaid Alantry
- Basic Medical Sciences Department, Physiology unitUniazah College of Medicine and Medical SciencesQassim UniversityUnaizahSaudi Arabia
| | - Lina Mohammed Atef
- Department of Dermatology, Venereology, and SexologyFaculty of MedicineSuez Canal UniversityIsmailiaEgypt
| |
Collapse
|
3
|
Paschalidou E, Katsaras G, Papoulakis T, Kalloniati E, Kavvadas D, Karachrysafi S, Kapoukranidou D, Tagarakis G, Papamitsou T. The Effect of Isotretinoin on Insulin Resistance and Serum Adiponectin Levels in Acne Vulgaris Patients: A Systematic Review and Meta-Analysis. Clin Pract 2024; 14:1021-1037. [PMID: 38921259 PMCID: PMC11202953 DOI: 10.3390/clinpract14030081] [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: 04/15/2024] [Revised: 05/15/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Isotretinoin is the drug of choice for severe acne. We sought to examine the potential link between isotretinoin and insulin resistance. METHODS We conducted a systematic review and meta-analysis in accordance with the PRISMA statement. A comprehensive search of the PubMed/MEDLINE, SCOPUS, and Cochrane databases was performed until 12 January 2022 utilizing the PICO (Patient, Intervention, Comparison, Outcome) tool. Fifteen English-language studies focusing on isotretinoin-treated acne patients were included. Serum levels of insulin, glucose, and adiponectin were evaluated before and after treatment, and insulin sensitivity was assessed using the HOMA-IR. A meta-analysis was conducted using RevMan 5.4.1 software, and a quality assessment was undertaken using the ROBINS-I tool. RESULTS The meta-analysis unveiled a statistically significant rise in the post-treatment levels of adiponectin, an anti-inflammatory agent, which inhibits liver glucose production while enhancing insulin sensitivity (SMD = 0.86; 95% confidence interval (95% CI) = 0.48-1.25, p-value < 0.0001; I2 = 58%). Our subgroup analysis based on study type yielded consistent findings. However, no statistically significant outcomes were observed for insulin, glucose levels, and the HOMA-IR. CONCLUSIONS There is not a clear association between isotretinoin and insulin resistance, but it appears to enhance the serum levels of adiponectin, which participates in glucose metabolism.
Collapse
Affiliation(s)
- Eleni Paschalidou
- Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (T.P.)
| | - Georgios Katsaras
- Department of Paediatrics, General Hospital of Pella—Hospital Unit of Edessa, 58200 Edessa, Greece;
| | - Thomas Papoulakis
- Faculty of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (E.P.); (T.P.)
| | - Evangelia Kalloniati
- Department of Dermatology, General Hospital of Katerini, 60100 Katerini, Greece;
| | - Dimitrios Kavvadas
- Histology-Embryology Laboratory, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.K.); (S.K.)
- Research Team “Histologistas”, Interinstitutional Postgraduate Program “Health and Environmental Factors”, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Sofia Karachrysafi
- Histology-Embryology Laboratory, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.K.); (S.K.)
- Research Team “Histologistas”, Interinstitutional Postgraduate Program “Health and Environmental Factors”, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Dorothea Kapoukranidou
- Department of Physiology, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Georgios Tagarakis
- Department of Cardiology, AHEPA University Hospital, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece;
| | - Theodora Papamitsou
- Histology-Embryology Laboratory, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.K.); (S.K.)
- Research Team “Histologistas”, Interinstitutional Postgraduate Program “Health and Environmental Factors”, Department of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| |
Collapse
|
4
|
AbdElneam AI, Al-Dhubaibi MS, Bahaj SS, Mohammed GF, Atef LM. Apo B-48 gene expression and low-density lipoprotein as a factor for increased insulin resistance and severity of acne. Gene 2023; 885:147703. [PMID: 37572798 DOI: 10.1016/j.gene.2023.147703] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND The contribution of insulin to acne is that it stimulates the synthesis of androgenic hormones, which are important in the development of excess sebum, hyperkeratinization, and sebaceous gland cell growth. OBJECTIVE To ascertain whether the lipid profile abnomalies seen in acne vulgaris are genetically induced, we also seek to establish a link between insulin resistance and lipid profiles. METHODS An analytical cross-sectional study with case-control design research investigation of 72 individuals with acne vulgaris and 72 healthy volunteers was carried out. Both groups' medical histories were taken, as were the severity and duration of the disease among acne sufferers, as well as demographic data. Anthropometry tests were performed on both groups, including their weights, height, and circumference of waist, as well as the profile of lipids, blood glucose levels after a fast, insulin levels during fasting, resistance to insulin, and Apo B-48 folding change. RESULTS Severe acne vulgaris patients showed significantly increased TG, TC, LDL-C, blood glucose levels after a fast, fasting insulin, and resistance to insulin levels. P = 0.005 showed that Apo B-48 expression increased in patients compared to healthy people. Apo B-48 folding change and insulin resistance were found to have a substantial positive simple linear association. Acne vulgaris, whether mild, moderate, or severe, has a significant positive linear connection with insulin resistance. CONCLUSION Acne patients had an abnormal in lipid profile. Acne individuals with severe form are more inclined to acquire resistance to insulin as well as higher glucose and insulin levels. Apo B-48 gene expression is elevated in acne individuals with severe form who have lipid abnormalities. This illustrating the importance of genetic variables in acne, insulin resistance, lipid profile modifications as well as Isotretinoin, a standard acne medication, can also cause lipid irregularities.
Collapse
Affiliation(s)
- Ahmed Ibrahim AbdElneam
- Department of Clinical Biochemistry, Department of Basic Medical Sciences, College of Medicine, Shaqra University, Dawadmi, Saudi Arabia; Molecular Genetics and Enzymology Department, Human Genetics and Genome Research Institute, National Research Center, 33 El Bohouth St. (former El Tahrir St.), Dokki 12622, Cairo, Egypt.
| | | | - Saleh Salem Bahaj
- Department of Microbiology and Immunology, Faculty of Medicine and Health Sciences, Sana'a University, Yemen.
| | - Ghada Farouk Mohammed
- Department of Dermatology, Venereology, and Sexology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| | - Lina Mohamed Atef
- Department of Dermatology, Venereology, and Sexology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
| |
Collapse
|
5
|
Gruszczyńska M, Sadowska-Przytocka A, Szybiak W, Więckowska B, Lacka K. Insulin Resistance in Patients with Acne Vulgaris. Biomedicines 2023; 11:2294. [PMID: 37626790 PMCID: PMC10452885 DOI: 10.3390/biomedicines11082294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Acne vulgaris presents multifactorial pathogenesis, which may include insulin resistance. To investigate whether insulin resistance is a causative factor in acne vulgaris development, this cohort study and a systematic review were conducted. A cohort of 41 acne vulgaris patients and 47 healthy BMI-matched controls were recruited. Glucose and insulin fasting serum levels were obtained and the HOMA-IR was calculated; insulin resistance was diagnosed in cases with a HOMA-IR value over 2.1. The mean ± SD values for glucose fasting serum level were as follows: 94.88 ± 7.731 (mg/dL) in the study group and 79.51 ± 7.175 (mg/dL) in the controls (p < 0.001). The mean ± SD insulin fasting serum levels were 14.47 ± 6.394 (µIU/mL) and 11.83 ± 4.309 (µIU/mL) (p = 0.059), respectively. The HOMA-IR mean ± SD value calculated for the study group was 3.4 ± 1.49 and, in the control group, it was 2.34 ± 0.909 (p < 0.001). Out of 41 patients, 32 were diagnosed with insulin resistance (78%), and 26 of the 47 controls were diagnosed with IR (55%) (p = 0.026). An insulin resistance diagnosis was statistically more common among the acne patients, compared to the controls. In the articles reviewed in this paper, insulin resistance was found to be more frequent in acne vulgaris patients. Both our study and the papers analyzed in the review indicate that insulin resistance might be an independent factor in acne vulgaris development and should be considered when diagnosing and treating acne.
Collapse
Affiliation(s)
- Michalina Gruszczyńska
- Students’ Scientific Society at Poznań University of Medical Sciences, Student’s Scientific Section of Endocrinology, Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (M.G.)
| | | | - Weronika Szybiak
- Students’ Scientific Society at Poznań University of Medical Sciences, Student’s Scientific Section of Endocrinology, Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (M.G.)
| | - Barbara Więckowska
- Department of Computer Sciences and Statistics, Poznań University of Medical Sciences, 61-701 Poznan, Poland
| | - Katarzyna Lacka
- Department of Endocrinology, Metabolism and Internal Medicine, Poznań University of Medical Science, 61-701 Poznan, Poland
| |
Collapse
|
6
|
Albalwa K, Kenawy M, El‐fallah AA, Salem RM. Serum and salivary adipsin levels and its association with insulin resistance in acne vulgaris patients. J Cosmet Dermatol 2022; 22:1354-1360. [PMID: 36459421 DOI: 10.1111/jocd.15545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND There is scarcity in literature about the reliability of salivary markers in acne vulgaris. AIMS The aims were to evaluate the insulin resistance (IR) and adipsin levels in serum and saliva in a sample of acne vulgaris patients; and to correlate IR and adipsin levels with the disease severity. METHODS This prospective case-control study included 60 acne vulgaris patients (patients Group), in addition, 60 apparently healthy individuals (control group). The severity of acne vulgaris was determined according to Global Acne Grading system (GAGS). Serum and salivary adipsin, fasting glucose, and fasting insulin levels were measured using ELISA kits. RESULTS Fasting glucose, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) in patients group both in serum and saliva were elevated when compared with the control group. Serum and salivary levels of adipsin and Quantitative insulin sensitivity check index (QUIKI) in patients were decreased than the control group. Adipsin serum levels show significant negative correlations with all study variables except QUIKI with which the correlation was positive both in serum and saliva. There was a significant positive correlation between serum and salivary adipsin levels (r = 0.873, p < 0.00001) and serum and salivary fasting glucose (r = 1, p < 0.00001). CONCLUSION Adipsin could be considered as a promising biomarker for acne vulgaris and its associated insulin resistance. Moreover, the salivary measurements may be considered as useful biomarkers in acne vulgaris patients, but more studies are still required.
Collapse
Affiliation(s)
- Kawther Albalwa
- Dermatology Resident at Alramadi Teaching Hospital Alramadi Iraq
| | - Mohammed Kenawy
- Department of Dermatology and Andrology, Faculty of Medicine Benha University Benha Egypt
| | - Asmaa Adel El‐fallah
- Chemical and Clinical Pathology, Faculty of Medicine Benha University Benha Egypt
| | - Rehab Mohammed Salem
- Department of Dermatology and Andrology, Faculty of Medicine Qalubia Governorate, Benha University Benha Egypt
| |
Collapse
|
7
|
Kaźmierska A, Bolesławska I, Polańska A, Dańczak-Pazdrowska A, Jagielski P, Drzymała-Czyż S, Adamski Z, Przysławski J. Effect of Evening Primrose Oil Supplementation on Selected Parameters of Skin Condition in a Group of Patients Treated with Isotretinoin-A Randomized Double-Blind Trial. Nutrients 2022; 14:nu14142980. [PMID: 35889936 PMCID: PMC9317771 DOI: 10.3390/nu14142980] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Retinoids, which include isotretinoin, reduce sebum levels, the degree of epidermal wetness (CORN) and cause an increase in transepidermal water loss (TEWL). Weight gain has also been observed in isotretinoin-treated patients. An agent that can reduce the severity of isotretinoin side effects is evening primrose oil (Oenothera paradoxa). The purpose of this study was to evaluate the effect of evening primrose oil supplementation in patients with acne vulgaris treated with isotretinoin on skin hydration status (CORN), transepidermal water loss (TEWL), skin oiliness (sebum) and changes in body weight and BMI. Methods: Patients diagnosed with acne were assigned to the isotretinoin-treated group (n = 25) or the isotretinoin and evening primrose oil-treated group (n = 25). The intervention lasted 9 months. CORN (with a corneometer), TEWL (with a tewameter) and sebum (with a sebumeter) were assessed twice, as well as body weight and BMI (Tanita MC-780). Results: The isotretinoin-treated group showed statistically significant reductions in CORN (p = 0.015), TEWL (p = 0.004) and sebum (p < 0.001) after the intervention. In the group treated with isotretinoin and evening primrose oil, TEWL and sebum levels also decreased significantly (p < 0.05), while CORN levels increased from 42.0 ± 9.70 to 50.9 ± 10.4 (p = 0.017). A significant decrease in body weight (p < 0.001) and BMI (p < 0.001) was observed in both groups after 9 months of intervention. Conclusions: During isotretinoin treatment, supplementation with evening primrose oil increased skin hydration. However, there were no differences between groups in transepidermal water loss, skin oiliness, weight loss and BMI.
Collapse
Affiliation(s)
- Agnieszka Kaźmierska
- Department of Bromatology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (A.K.); (S.D.-C.); (J.P.)
| | - Izabela Bolesławska
- Department of Bromatology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (A.K.); (S.D.-C.); (J.P.)
- Correspondence:
| | - Adriana Polańska
- Laboratory of Connective Tissue Diseases, Department of Dermatology and Venereology, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | | | - Paweł Jagielski
- Department of Nutrition and Drug Research, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Krakow, Poland;
| | - Sławomira Drzymała-Czyż
- Department of Bromatology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (A.K.); (S.D.-C.); (J.P.)
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (A.D.-P.); (Z.A.)
| | - Juliusz Przysławski
- Department of Bromatology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (A.K.); (S.D.-C.); (J.P.)
| |
Collapse
|
8
|
Akpolat D. Unexpected Effects of Oral Isotretinoin in Adolescents With Acne Vulgaris. Cureus 2021; 13:e17115. [PMID: 34548957 PMCID: PMC8437010 DOI: 10.7759/cureus.17115] [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] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
Background This study aimed to assess the effects of isotretinoin treatment on hirsutism, menstrual cycle and hormonal response in adolescents with acne vulgaris (AV). Methods In the study, 76 participants with nodulocystic acne were included. Free testosterone (fT), total testosterone (tT), dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), 17-OH progesterone (17-OH PG), and sex hormone-binding globulin (SHBG) levels of the participants were measured before and at the third and sixth months of treatment. Furthermore, the patients were evaluated for hirsutism and menstrual irregularity. Results The rates of menstrual irregularity and hirsutism at the beginning and at the third and sixth months of treatment were found to be different (p < 0.05). fT, tT and DHEAS levels at the third and sixth months of treatment were higher than those at the beginning of treatment, and the SHBG level at the sixth month was found to be lower than that at the beginning and third month of treatment (p < 0.05). The tT levels were found to be lower and DHEAS levels were higher than those at the beginning of treatment in patients who presented with menstrual irregularity at the third month of treatment (p < 0.05). The LH and 17-OH PG levels were noted to be lower and DHEAS levels were higher than those at the beginning of treatment in patients who developed hirsutism at the third month of treatment (p < 0.05). The SHBG levels were observed to be lower and DHEAS levels were higher than those before treatment in patients who developed menstrual irregularity at the sixth month of treatment (p < 0.05). SHBG levels were discerned to be lower and DHEAS levels were higher compared to those at the beginning of treatment in patients who developed hirsutism at the sixth month of the treatment (p < 0.05). Conclusions Isotretinoin can cause alterations in the adrenal hormone levels. Hirsutism and menstrual irregularity can be observed during treatment follow-ups.
Collapse
|
9
|
The impact of isotretinoin on the pituitary-ovarian axis: An interpretative review of the literature. Reprod Toxicol 2021; 104:85-95. [PMID: 34224824 DOI: 10.1016/j.reprotox.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022]
Abstract
Isotretinoin (13-cis-retinoic acid), a derivative of vitamin A, is used in the treatment of severe acne resulting in sebum suppression induced by sebocyte apoptosis. Isotretinoin treatment is associated with several adverse effects including teratogenicity, hepatotoxicity, and dyslipidemia. Isotretinoin's effects on endocrine systems and its potential role as an endocrine disruptor are not yet adequately investigated. This review presents clinical, endocrine, and molecular evidence showing that isotretinoin treatment adversely affects the pituitary-ovarian axis and enhances the risk of granulosa cell apoptosis reducing follicular reserve. Isotretinoin is associated with pro-apoptotic signaling in sebaceous glands through upregulated expression of p53, forkhead box O transcription factors (FOXO1, FOXO3), and tumor necrosis factor-related apoptosis inducing ligand (TRAIL). Two literature searches including clinical and experimental studies respectively support the hypothesis that isotretinoin's toxicological mode of action on the pituitary-ovarian axis might be caused by over-expressed p53/FOXO1 signaling resulting in gonadotropin suppression and granulosa cell apoptosis. The reduction of follicular reserve by isotretinoin treatment should be especially considered when this drug will be administered for the treatment of acne in post-adolescent women, in whom fertility may be adversely affected. In contrast, isotretinoin treatment may exert beneficial effects in states of hyperandrogenism, especially in patients with polycystic ovary syndrome.
Collapse
|
10
|
Aktar R, Gunes Bilgili S, Yavuz IH, Ozaydin Yavuz G, Aktar S, Ozturk M, Karadağ AS. Evaluation of hirsutism and hormonal parameters in acne vulgaris patients treated with isotretinoin. Int J Clin Pract 2021; 75:e13791. [PMID: 33099851 DOI: 10.1111/ijcp.13791] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/16/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Although the effect of isotretinoin use on hormonal changes in acne pathogenesis is not fully known, there are limited studies on its effects on the development of hirsutism. In this study, it was aimed to evaluate the effect of isotretinoin use on hirsutism and hormonal parameters in patients with acne vulgaris. METHODS In this study, 30 female acne patients and 30 healthy females were evaluated prospectively. Menstrual irregularity, LH, FSH, prolactin, progesterone, 17-OH progesterone, oestradiol, total testosterone, DHEA-S, insulin, glucose, TSH levels, Ferriman-Gallwey (FG) score and ultrasonography (USG) findings of control group and patient group were recorded. RESULTS Pre-treatment progesterone (P = .007) and oestradiol (P = .001) levels of the patients were statistically lower than the control group. In the patient group, menstrual irregularity (P < 001) and FG hirsutism score at the third month of treatment were significantly higher than before treatment. In 10% of the patients, there were abnormal findings on pelvic USG in the third month of treatment. CONCLUSION In our study, it could not be revealed that isotretinoin has a significant effect on pituitary, adrenal hormones and insulin resistance. We found that 3 months of isotretinoin treatment caused an increase in menstrual irregularity and FG hirsutism score.
Collapse
Affiliation(s)
- Rojda Aktar
- Department of Dermatology, Kahta State Hospital, Adiyaman, Turkey
| | - Serap Gunes Bilgili
- Department of Dermatology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Ibrahim Halil Yavuz
- Department of Dermatology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Goknur Ozaydin Yavuz
- Department of Dermatology, Faculty of Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Siraç Aktar
- Department of Dermatology, Bismil State Hospital, Diyarbakir, Turkey
| | - Murat Ozturk
- Department of Dermatology, Health Sciences University, Van Training and Research Hospital, Van, Turkey
| | - Ayşe Serap Karadağ
- Department of Dermatology, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
11
|
Pektas SD, Cinar N, Duman DD, Kara A, Batu J, Karakas-Celik S, Aksoy DY. The relationship among androgens, insulin resistance and ghrelin polymorphisms in post-adolescent male patients with severe acne vulgaris. Postepy Dermatol Alergol 2020; 37:800-809. [PMID: 33240024 PMCID: PMC7675091 DOI: 10.5114/ada.2020.100492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 04/01/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Ghrelin has anti-inflammatory and immunomodulatory activities. Data about the role of ghrelin and ghrelin polymorphisms in the development of acne vulgaris in post-adolescent male patients are limited. AIM To evaluate the role of serum androgens, insulin resistance, ghrelin and ghrelin polymorphisms in severe acne vulgaris. MATERIAL AND METHODS Thirty-five post-adolescent male patients with a mean age of 28.0 ±5.4 years and 33 age-and BMI-matched controls were enrolled. Serum androgens, lipids, insulin sensitivity parameters and ghrelin levels were determined. The PCR method was used for GHRL polymorphisms (rs27647, rs696217 and rs34911341 genotypes). RESULTS Patients had similar anthropometric measures to controls, except a significantly higher WHR in patients (0.92 ±0.06 vs. 0.86 ±0.08, p < 0.05). Also, FPG, HOMA-IR values, lipid profile and serum androgen levels were similar. Interestingly, patients had significantly lower ghrelin levels than controls (4.5 ±5.8 vs. 101.2 ±86.5 pg/ml, p < 0.001). The frequencies of rs696217 and rs34911341 genotypes were similar whereas the distribution of rs27647 alleles was significantly different between the groups (p < 0.05). GA and GG genotypes of GHRL rs27647 polymorphism indicated an increased risk of developing acne vulgaris (OR = 11.156, 95% CI: 2.864-43.464, OR = 5.312, 95% CI: 1.269-22.244, respectively; p < 0.05). Patients with rs27647-AA polymorphism had significantly lower GAGS scores than other groups (AA genotype 6.7 ±14.1 vs. GA genotype 24.6 ±15.7 and GG genotype 19.4 ±17.9, p < 0.001). None of the polymorphisms had a significant effect on metabolic parameters, insulin sensitivity and serum ghrelin levels. CONCLUSIONS Decreased ghrelin levels and GA and GG genotypes of GHRL gene rs27647 polymorphism may have a role in the pathogenesis of acne vulgaris.
Collapse
Affiliation(s)
- Suzan Demir Pektas
- Department of Dermatology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Nese Cinar
- Department of Endocrinology and Metabolic Diseases, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | | | - Ahmet Kara
- Department of Family Medicine, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | | | - Sevim Karakas-Celik
- Department of Molecular Biology and Genetic, Faculty of Science, Bulent Ecevit University, Zonguldak, Turkey
| | | |
Collapse
|
12
|
Della Corte L, Foreste V, Barra F, Gustavino C, Alessandri F, Centurioni MG, Ferrero S, Bifulco G, Giampaolino P. Current and experimental drug therapy for the treatment of polycystic ovarian syndrome. Expert Opin Investig Drugs 2020; 29:819-830. [PMID: 32543238 DOI: 10.1080/13543784.2020.1781815] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects 8-13% of reproductive-age women. Irregular periods, hirsutism, or infertility are the most common clinical presentations of patients affected by PCOS. This syndrome is also linked to metabolic abnormalities such as type 2 diabetes, insulin resistance and obesity. The optimal therapeutic approach is still unknown. AREAS COVERED This narrative review offers an overview of the literature on current and experimental pharmacological options for treating PCOS and highlights ongoing clinical trials. Several electronic databases were searched and current research registers were analyzed to the present year. The papers selected for this review were critically analyzed, and all data available were summarized, organized, and explored to derive key information. EXPERT OPINION The main goal of PCOS treatment is to obtain a metabolic and hormonal balance. Optimal PCOS therapy should be direct to the reproductive abnormalities and the entire spectrum of endocrine and metabolic complications that appear to have a long-term negative impact on PCOS patient health, as in post-menopausal period. The discovery of new mechanisms in PCOS pathogenesis will offer the possibility of testing new drug classes.
Collapse
Affiliation(s)
- Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II" , Naples, Italy
| | - Virginia Foreste
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II" , Naples, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa , Genoa, Italy
| | - Claudio Gustavino
- Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | - Franco Alessandri
- Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy
| | | | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino , Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa , Genoa, Italy
| | - Giuseppe Bifulco
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II" , Naples, Italy
| | - Pierluigi Giampaolino
- Department of Public Health, School of Medicine, University of Naples Federico II , Naples, Italy
| |
Collapse
|
13
|
Bagatin E, de Freitas THP, Machado MCR, Ribeiro BM, Nunes S, da Rocha MAD. Adult female acne: a guide to clinical practice. An Bras Dermatol 2019; 94:62-75. [PMID: 30726466 PMCID: PMC6360964 DOI: 10.1590/abd1806-4841.20198203] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 06/10/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Acne in women is often associated with anxiety and depression, and may persist from adolescence as well as manifest for the first time in adulthood. Genetic and hormonal factors contribute to its etiopathogenesis, and maintenance treatment is required, usually for years, due to its clinical evolution. OBJECTIVE To develop a guide for the clinical practice of adult female acne. METHODS A team of five experts with extensive experience in acne conducted a literature review of the main scientific evidence and met to discuss the best practices and personal experiences to develop a guide containing recommendations for the clinical practice of adult female acne. RESULTS The group of specialists reached consensus on the main guidelines for clinical practice, providing detailed recommendations on clinical picture, etiopathogenesis, laboratory investigation and treatment of adult female acne. CONCLUSION Different from teenage acne, adult female acne presents some characteristics and multiple etiopathogenic factors that make its management more complex. This guide provides recommendations for best clinical practices and therapeutic decisions. However, the authors consider that additional studies are needed in order to provide more evidence for adult female acne to be better understood.
Collapse
Affiliation(s)
- Edileia Bagatin
- Department of Dermatology, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo (SP), Brazil
- Program of Post-Graduation in Translational Medicine, Escola
Paulista de Medicina, Universidade Federal de São Paulo, São Paulo
(SP), Brazil
| | - Thais Helena Proença de Freitas
- Dermatology Service, Hospital da Santa Casa de São Paulo,
Brazil
- Dermatology Clinic, Departamento de Clínica Médica,
Santa Casa de São Paulo, São Paulo (SP), Brazil
| | - Maria Cecilia Rivitti Machado
- Department of Dermatology, Hospital das Clínicas, Faculdade
de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil
- Discipline of Dermatology, Faculdade de Medicina, Universidade
Metropolitana de Santos, Santos (SP), Brazil
| | - Beatriz Medeiros Ribeiro
- Dermatology Service, Hospital Regional da Asa Norte, Secretaria de
Saúde do Distrito Federal, Brasília (DF), Brazil
| | | | - Marco Alexandre Dias da Rocha
- Service of Cosmiatry, Department of Dermatology, Escola Paulista de
Medicina, Universidade Federal de São Paulo, São Paulo (SP),
Brazil
| |
Collapse
|
14
|
Effects of isotretinoin on body mass index, serum adiponectin, leptin, and ghrelin levels in acne vulgaris patients. Postepy Dermatol Alergol 2016; 33:294-9. [PMID: 27605902 PMCID: PMC5004210 DOI: 10.5114/pdia.2016.56928] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/31/2015] [Indexed: 12/21/2022] Open
Abstract
Introduction Isotretinoin has been successfully used for the treatment of acne vulgaris. Aim To investigate the effects of isotretinoin on body mass index (BMI), to determine whether isotretinoin causes any changes in serum adiponectin, leptin, and ghrelin levels in acne vulgaris patients, and to correlate variables. Material and methods Thirty-two patients were included in this study. Oral isotretinoin was begun at a dose of 0.5–0.6 mg/kg and raised to 0.6–0.75 mg/kg. Pretreatment and posttreatment third-month BMI and adiponectin, leptin, and ghrelin serum levels were measured. Results The pre- and posttreatment BMI values were not significantly different. In addition, serum adiponectin and leptin levels were significantly increased following isotretinoin therapy while serum ghrelin levels were not different. Conclusions Isotretinoin may exert its anti-inflammatory activity by increasing leptin and adiponectin levels.
Collapse
|
15
|
Ramot Y, Sheffer S, Zlotogorski A. Severe Facial Hirsutism Following Isotretinoin Therapy: An Under-reported Entity. Int J Trichology 2015; 7:129-30. [PMID: 26622158 PMCID: PMC4639958 DOI: 10.4103/0974-7753.167466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hirsutism is usually a manifestation of hyperandrogenism, and iatrogenic causes for excess hair growth are uncommon. Here, we report on a 48-year-old female patient, who developed severe excess facial hair following treatment with isotretinoin for papulopustular rosacea. To the best of our knowledge, only one case has been reported before, and not in the dermatology literature. Taking into consideration the fact that isotretinoin is a widely prescribed medication in the dermatology practice, information on its possible adverse effects is of major importance for the treating dermatologist.
Collapse
Affiliation(s)
- Yuval Ramot
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sivan Sheffer
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Abraham Zlotogorski
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| |
Collapse
|
16
|
Cinar N, Cetinozman F, Aksoy DY, Elcin G, Yildiz BO. Comparison of adrenocortical steroidogenesis in women with post-adolescent severe acne and polycystic ovary syndrome. J Eur Acad Dermatol Venereol 2014; 29:875-80. [PMID: 25176476 DOI: 10.1111/jdv.12696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 07/17/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increased adrenocortical production appears to be associated with acne and hirsutism in acne and polycystic ovary syndrome (PCOS). However, the aetiological role of androgens in the pathogenesis of acne per se is far from being clear. OBJECTIVE We aimed to evaluate adrenocortical function in women with post-adolescent severe acne in comparison with patients with PCOS and healthy women. METHODS The study included 32 women with post-adolescent severe acne, 32 women with PCOS and 32 age and body mass index (BMI)-matched healthy controls (age 17-34 years, BMI: 20.8 ± 1.9 kg/m²). Women with acne did not have hirsutism or ovulatory dysfunction whereas all PCOS patients had androgen excess and ovulatory dysfunction. Measurements included basal testosterone (T), sex hormone-binding globulin (SHBG) and dehydroepiandrosterone sulphate (DHEAS) levels and serum 17-hydroxyprogesterone (17-OHP), androstenedione (A4), DHEA and cortisol levels in response to corticotropin (ACTH) stimulation. RESULTS T, free androgen index, DHEAS levels, basal and AUC (area under the curve) values for A4 were significantly higher in PCOS than women with acne and controls (P < 0.05 for all), whereas three groups did not differ for basal or AUC values of DHEA and cortisol. Women with PCOS and those with severe acne had significantly and similarly higher AUC values of 17-OHP compared to controls (P < 0.05). CONCLUSION Women with isolated post-adolescent severe acne do not have increased levels of adrenal androgens basally or in response to ACTH. However, these women have similar secretion pattern of 17-OHP with PCOS patients suggesting increased enzymatic activity in this pathway.
Collapse
Affiliation(s)
- N Cinar
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Hacettepe University School of Medicine, Hacettepe, Ankara, 06100, Turkey
| | | | | | | | | |
Collapse
|