Insulin resistance in severe acne vulgaris

Investigating metabolic syndrome markers and body mass index changes in patients with acne vulgaris treated with isotretinoin: A prospective study

BACKGROUND

Acne vulgaris is a common inflammatory skin disease that occurs during puberty, affecting approximately 85% of young adults and may persist into adulthood. The pathophysiology of acne is multifactorial, involving hormonal, inflammatory, and immune mechanisms. Isotretinoin is widely used for treating severe cystic acne or recurrent acne. This medication is considered a pharmacological option that significantly reduces sebum secretion, leading to a reduction in the size of sebaceous glands. It also induces a lack of differentiation in sebaceous cysts, resulting in a decrease in lipid accumulation.

METHOD

This research is a prospective study. Patient contact details were obtained directly from those visiting the dermatology clinic, and they were monitored for a duration of 3 months. Essential data was gathered through patient examinations and inquiries at the clinic, including the prescription of tests prior to initiating isotretinoin treatment. Furthermore, follow-up tests and examinations were performed within the initial and third months post-treatment commencement.

RESULTS

Sixty-two patients participated in the study, selected through non-probability (convenience) sampling. The therapeutic dose taken by patients was 20 mg of isotretinoin daily (n = 49) or every other day (n = 13). Among the participants, six patients experienced a decrease of 3 units or more in HDL levels, while 16 patients saw an increase of 3 units or more in LDL levels, 3 months after beginning the treatment. Additionally, the triglyceride (TG) levels increased by 9 units or more in six individuals, and the blood sugar (BS) levels increased by 5 units or more in nine individuals, 3 months after treatment initiation. Moreover, one person's waist circumference increased by 1.5 cm 3 months after treatment began. The average weight of the individuals at the end of the treatment rose from 60.74 kg to 61.12 kg. However, this weight increase was not statistically significant. (p > 0.05).

CONCLUSION

In general, the results of our study show that the use of oral isotretinoin as a treatment option for the management of acne vulgaris can be effective when administered at the correct dosage, offering a safe and low-complication option.

In severe acne vulgaris, TNF-α gene variants are connected to increased TNF-α gene expression and insulin resistance

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.

Oily fish reduces the risk of acne by lowering fasting insulin levels: A Mendelian randomization study

Meat intake, particularly from oily fish, has been associated with various chronic diseases. However, its relationship with acne has always been controversial. Therefore, we have adopted Mendelian randomization (MR) analysis to investigate the causal relationship between different types of meat intake and acne. The exposure and outcome datasets for this study were obtained from the Integrative Epidemiology Unit (IEU) Open GWAS project. Seven datasets on meat intake were included, which consisted of non-oily fish, oily fish, lamb/mutton, poultry, pork, beef, and processed meat. The main methods used for MR analysis were inverse variance weighted, weighted median, and MR-egger. To ensure the accuracy of the results, heterogeneity, pleiotropy, and Mendelian randomization pleiotropy residual sum and outlier (MR-PRESSO) analyses were conducted. Additionally, an analysis of four risk factors (fasting insulin, insulin resistance, total testosterone level, and estradiol level) was performed to investigate the underlying mechanisms linking statistically significant meat intake to acne. Oily fish intake was found to be a protective factor for acne (OR: 0.22, 95% CI: 0.10-0.49, p < .001), and it was also observed that oily fish intake can reduce the level of fasting insulin by the IVW method (OR: 0.89, 95% CI: 0.81-0.98, p = .02). No causal relationship was identified between other types of meat intake and acne. The intake of oily fish reduces the risk of acne by lowering fasting insulin levels.

A Study of FoxO1, mTOR, miR-21, miR-29b, and miR-98 Expression Levels Regarding Metabolic Syndrome in Acne Vulgaris Patients

BACKGROUND

Acne vulgaris (AV) is an inflammatory skin disease caused by the mechanistic target of rapamycin complex 1 (mTORC1). forkhead box protein (Fox) O1 is known to regulate the relationship between the mTORC1 signaling pathway and insulin resistance (IR). Increased mTORC1 signaling is known to predispose one to diseases such as insulin resistance (IR), obesity, and diabetes mellitus. One of the major components of mTORC1 is mTOR. FoxO1 and mTOR play key roles in the onset and progression of metabolic syndrome (MetS). In this study, we aimed to elucidate the relationship between AV and MetS through FoxO1 and mTOR signaling pathways and microRNAs (miRs) associated with these signaling pathways.

METHODS

We examined 20 AV patients without MetS, 16 AV patients with MetS, and 20 healthy controls. The demographic characteristics of the patients, MetS parameters, clinical severity of AV (Global Acne Grading System, GAGS), and the homeostasis model assessment (HOMA) values were compared between the groups. In addition, the expression levels of FoxO1 and mTOR genes, along with the expression levels of miR-21, miR-29b, and miR-98, were assessed in skin biopsy samples from all groups using real-time polymerase chain reaction methods. FoxO1, mTOR, and miRNA expression levels were recorded as fold change.

RESULTS

The mean age of patients with AV without MetS was statistically lower. In AV patients with MetS, those with moderate GAGS scores had statistically significantly higher HOMA values than those with mild GAGS scores. FoxO1 expression was significantly lower in AV patients compared to controls. The mTOR expression levels of AV patients with MetS were significantly higher than the other two groups. The expression levels of miR-21 and miR-29b were significantly increased in the group of AV patients with MetS compared to the group of AV patients without MetS.

CONCLUSIONS

These results suggested that the mTOR pathway may play an important role in explaining the relationship between AV and MetS in acne pathogenesis. They also suggested that miR-21 and miR-29b play a role in the inflammatory process of AV.

Effect of interleukin-12 gene expression on insulin resistance in patients with acne vulgaris

BACKGROUND

Insulin resistance (IR) is a condition where cells become resistant to insulin, causing impaired glucose uptake and increased blood glucose levels. Interleukin-12 (IL-12), a cytokine, regulates the immune system. High levels of IL-12 can lead to chronic inflammation, exacerbate resistance to insulin, and contribute to type 2 diabetes. Also, link IR to acne vulgaris (AV), as it reduces tissue sensitivity to insulin, causing increased insulin levels and sebum production, which can contribute to acne development.

AIM

To explore the role of IL-12 gene expression on IR in AV patients and to study the role of IL-12 gene in the development of AV.

SUBJECTS AND METHODS

A case-control study was performed on 68 AV patients and 68 healthy controls. The biochemical analysis included fasting glucose, fasting insulin, (HOMA-IR), and serum IL-12 level. IL-12 gene expression was performed by quantitative real-time PCR for both two groups. In addition, folding change was calculated by using the standard 2-(∆∆Ct) method.

RESULT

IL-12 level, IL-12 folding change, fasting insulin, and IR were all increased in acne patients. A highly significant linear correlation was found between IL-12 folding change and both IL-12 levels and IR. There is a substantial positive significant simple linear association between IL-12 level and IL-12 folding change, as well as IR and IL-12 folding change, in moderate and severe acne.

CONCLUSION

IL-12 gene has an important role in IR and the development of acne in AV patients.

Insulin and the sebaceous gland function

Insulin affects metabolic processes in different organs, including the skin. The sebaceous gland (SG) is an important appendage in the skin, which responds to insulin-mediated signals, either directly or through the insulin growth factor 1 (IGF-1) axis. Insulin cues are differently translated into the activation of metabolic processes depending on several factors, including glucose levels, receptor sensitivity, and sebocyte differentiation. The effects of diet on both the physiological function and pathological conditions of the SG have been linked to pathways activated by insulin and IGF-1. Experimental evidence and theoretical speculations support the association of insulin resistance with acne vulgaris, which is a major disorder of the SG. In this review, we examined the effects of insulin on the SG function and their implications in the pathogenesis of acne.

Insulin Resistance in Patients with Acne Vulgaris

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.

Metabolic and Dietary Factors in Acne Vulgaris and Evaluation of the Acne Vulgaris Treatment with Oral Contraceptive-Based Therapies in Young Adult Women

The etiopathogenesis of acne is complex, as several endo- and exogenous factors that affect the sebaceous-hair unit are involved in the development of acne lesions. The main aim of the study was to evaluate selected metabolic parameters before treatment. Another goal of the study was to determine the correlation between selected metabolic and dietary parameters and the severity of acne before treatment. The third objective was to assess the severity of acne before and after treatment, considering the type of treatment used. The final objective was to assess the relationship between the difference in acne severity before and after treatment, considering the type of treatment used and factors of dairy or sweets intake. 168 women participated in the study. The patients belonged to two groups: the study group (99 patients with acne vulgaris) and the control group (69 patients without skin lesions). The study group was divided into subgroups according to the treatment used: contraceptive preparation, contraceptive preparation and cyproterone acetate, and contraceptive preparation and isotretinoin preparation. We found that LDL levels and consumption of sweets correlated with acne severity. The mainstay of acne treatment is contraceptive treatment (ethinylestradiol and drospirenone). The effectiveness of the three contraceptive-based treatments was confirmed by observing the severity of acne. There were no significant correlations between the difference in acne severity before and after treatment with the three treatments and factors of dairy or sweet consumption.

The Relationship Between Acne Vulgaris and Insulin Resistance

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit that usually affects adolescents. The aetiology and severity of acne may be influenced by hyperinsulinemia and insulin resistance. A case-control study was conducted in the dermatology outpatient clinic of Al-Fayhaa Teaching Hospital in Basrah city. C-peptide and triglyceride-glucose (TyG) index levels were measured in 43 acne vulgaris patients who were age- and gender-matched with 48 controls. The results found that 81% and 67% of acne patients have insulin resistance based on their C-peptide and TyG index levels, respectively, and this is significantly higher than the control candidates (P = 0.001). Furthermore, a higher value of C-peptide was found among acne cases compared to controls (2.84 ± 1.23 vs. 1.68 ± 0.19) (P = 0.001), and a higher value of the TyG index was found among cases compared to controls (4.43 ± 0.17 vs. 3.38 ± 0.19) (P = 0.001), in addition to a significant positive and strong correlation between the level of these biomarkers and the acne severity (r = 0.760 for the C-peptide and 0.814 for the TyG index) (P = 0.001).

Insulin Resistance and Acne: The Role of Metformin as Alternative Therapy in Men

The association between acne and insulin resistance has not been investigated as thoroughly in males as it has been in women, despite the fact that in adult men, acne prevalence has grown. On the face, sebaceous glands produce and secrete sebum, which lubricates the skin and protects it from friction. Metformin, an insulin-sensitizing medication, may modify the association between acne vulgaris and insulin resistance (IR). Individuals with IR, metabolic syndrome or with impaired glucose tolerance are sometimes treated 'off label' with Metformin. In these conditions, IR may be a leading factor in the pathogenesis of acne, and in men, Metformin treatment may reduce the Global Acne Grading System (GAGS) score by enhancing insulin sensitivity. However, additional clinical studies are required to corroborate these assumptions.

Serum and salivary adipsin levels and its association with insulin resistance in acne vulgaris patients

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.

Potential roles of gut microbial tryptophan metabolites in the complex pathogenesis of acne vulgaris

Acne vulgaris is a chronic inflammatory skin disease in which the influence of gut microbiota has been implicated but without clarification of mechanisms. Gut microbiota may exert such an influence via metabolites, particularly those of tryptophan. End metabolites of tryptophan activate receptors, including aryl hydrocarbon, G protein-coupled, and pregnane X receptors to stabilize the immune microenvironment and intestinal mucosal homeostasis. Any impact on the pathogenesis of acne vulgaris remains unclear. The current review collates recent advances concerning potential roles of tryptophan metabolism in mediating skin inflammation, follicular sebaceous gland function and intestinal permeability, all of which influence the pathogenesis of acne vulgaris. The aim was to improve understanding of the pathogenesis of acne vulgaris and to expose therapeutic opportunities.

Untargeted metabolomics analysis of the plasma metabolic signature of moderate-to-severe acne

BACKGROUND

Acne vulgaris is a chronic inflammatory disease of pilosebaceous units and sebaceous glands. This study aimed to find out metabolites and metabolite pathways abnormal in moderate-to-severe acne vulgaris patients.

METHODS

The plasma metabolites LC-MS/MS analysis was conducted on 30 moderate-to-severe acne patients and 32 healthy controls. Multivariate data analyses were applied to identify the distinguishing metabolites.

RESULTS

Totally, 63 significant differential metabolites and 40 metabolic pathways were significantly changed. The top 3 metabolites on the basis of their VIP scores obtained from the PLS-DA were 2-Oxoadipic acid, Myo-inositol and Citrate. In addition, four sphingolipid metabolites include sphinganine, sphingosine, O-Phosphoethanolamine, and sphingomyelin (d18:1/18:0) were identified. The most closely related metabolic pathways included ATP-binding cassette (ABC) transporters and sphingolipid signaling pathway in moderate-to-severe acne patients.

CONCLUSIONS

The observed difference in metabolic profiles between acne patients and healthy controls provides a new insight into the link between plasma metabolic changes and acne vulgaris.

Non-conventional therapeutical approaches to acne vulgaris related to its association with metabolic disorders

The ever-increasing frequency of metabolic syndrome (MetS) is still a major challenge of the public health care system, worldwide. In recent years, researchers have been drawn to the uncommon (at first look) link between skin illnesses and MetS. Because of the pro-inflammatory mechanisms and insulin resistance (IR) that are upregulated in metabolic syndrome, many skin disorders are correlated to metabolic dysfunctions, including acne vulgaris. A comprehensive understanding of the link between MetS and acne vulgaris may contribute to the development of new treatment strategies. The current review focuses on dietary and therapeutic interventions and assesses the effect of various approaches such as improving diet by avoiding certain food products (i.e., milk and chocolate) or increasing the intake of others (i.e., food products rich in omega-3 fatty acids), metformin administration, therapy with plant extracts, plant essential oils, and probiotic supplementation on the improvement of certain acne vulgaris severity parameters. These therapeutic approaches, when combined with allopathic treatment, can improve the patients' quality of life.

Incretin serum level as a biomarker of insulin Resistance in acne vulgaris patients

OBJECTIVE

To investigate the relationship between serum Incretin and acne vulgaris (AV) and insulin resistance (IR), and to find the biological indicators of acne vulgaris with insulin resistance.

METHODS

60 patients diagnosed with acne vulgaris in the dermatology department of Zagazig University and 56 healthy people in the health examination center of this hospital were collected respectively as the control group; all the included people were drawn fasting blood to test serum Incretin, blood lipids, sex hormones and INS release test to explore the role of serum Incretin in acne vulgaris and insulin resistance.

RESULTS

The average level of Incretin in the acne group was lower than that in the control group, and the difference was statistically significant (t=7.189, P<0.001). The average level of Incretin in the acne group with insulin resistance was lower than that in the acne without insulin resistance group, the difference was statistically significant (t=22.328, P<0.001). In the acne group, the insulin resistance index decreased with the increase of Incretin level, and the two showed a negative correlation. (R = -0.711, P<0.001.( CONCLUSIONS: Patients with acne vulgaris are prone to have insulin resistance. Insulin resistance in patients with acne vulgaris is negatively correlated with Incretin. Serum Incretin may be expected to be a biomarker for diagnosing acne vulgaris patients with insulin resistance. The severity of acne vulgaris may have no obvious correlation with insulin resistance and serum incretin.

Serum Irisin: A Potential Diagnostic Marker for Insulin Resistance in Acne Vulgaris

Background

Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous unit. Many factors are involved in the occurrence of acne. It has been confirmed that some adipokines play an important role in the development of AV. Irisin is a novel adipokine, which is highly expressed in skeletal muscle, liver, and fat. It improves insulin resistance (IR) by inducing the browning of white adipose tissue, increasing heat production and energy expenditure.

Objective

The purpose of this study was to investigate the role of serum irisin as an adipokine to explore its function in the pathogenesis of AV and its correlation with IR, and whether it can be used as a potential biomarker of insulin sensitivity. Although the hyperinsulinemic-euglycemic clamp remains the gold standard for accurate determination of IR, it cannot be performed routinely. Various alternative simpler measures have been used, the most common being homeostasis model assessment. However, these metrics are limited by their accuracy, cost, and blood collection requirements.[1] Therefore, an effective and feasible serum biomarker is an attractive and relatively straightforward method, which may provide clinicians with a more accurate and simple method for the prediction and diagnosis of IR. IR can often be detected before other symptoms appear, so establishing an early diagnosis method will allow for the appropriate treatment of patients before the disease develops.

Patients and Methods

The study included 171 subjects; 115 patients with newly diagnosed AV and 56 apparently healthy subjects. The contents of irisin and interleukin-1 alpha in serum were determined by enzyme-linked immunosorbent assay. The IR index was calculated by the homeostasis model.

Results

Serum irisin levels in AV patients and control group were (24.0 ± 11.3) and (104.3 ± 27.0) ng/dl, respectively, which were significantly lower than those in control group (P < 0.001). Serum irisin was negatively correlated with IR (r = -0.711, P 0.001). The sensitivity of irisin was 100.0%, the specificity was 92.8%, and the cutoff point was 53.32. The decrease of serum irisin level could predict the patients with IR in acne.

Conclusion

Serum irisin levels in AV patients were significantly decreased. Serum irisin showed acceptable performance criteria in the diagnosis of AV with IR. Serum irisin seems to be a good diagnostic and prognostic marker for IR. Further multi-center studies are needed to confirm this link, which could pave the way for new treatment options.

Combination of metformin and berberine represses the apoptosis of sebocytes in high-fat diet-induced diabetic hamsters and an insulin-treated human cell line

Obesity and insulin resistance affect metabolic reactions, but their ensuing contributions to macrophage metabolism remain insufficiently understood. We investigated the contributions of berberine and metformin combination to the inhibition of sebocyte apoptosis in high-fat diet-induced diabetic hamsters and an insulin-treated human cell line. Golden hamsters were fed a high-glucose high-fat diet and administered a 6-week treatment with a combination of metformin and two concentrations of berberine (100 or 50 mg·kg^-1 ). Body weights of treated hamsters were remarkably reduced compared with those of controls. Histological examination indicated that berberine repressed liver fat accumulation. Moreover, insulin and glucose concentrations were noticeably decreased by the combination treatments. In glucose tolerance tests, hamsters receiving berberine displayed higher tolerance to glucose, compared with the control group. Sebocytes isolated from high-fat diet-induced diabetic hamsters and insulin-treated human sebocytes displayed elevated cell death rates, which were attenuated by berberine and metformin treatments. Further studies showed that the effects of metformin and berberine on cellular apoptosis were mediated via the Bik pathway. Thus, berberine may effectively decrease circulating glucose levels, ameliorate insulin resistance, reduce body weight, and attenuate sebocyte apoptosis in diabetic hamsters, potentially decreasing vulnerability to the cardiovascular complications of diabetes. SIGNIFICANCE OF THE STUDY: The present data indicate that insulin stimulates changes in the expression levels of cell death-associated proteins, which participate in sebaceous gland diseases during obesity or diabetes. The anti-apoptotic effects of BBR and MET in sebaceous gland cells are regulated partially by Bik expression. To the best of our knowledge, this study is the first to suggest cell death counteracting effects of BBR in hamster and human sebocytes as well as to propose BBR as an innovative therapeutic agent for insulin-related sebaceous gland diseases, including acne.

Skin disease related to metabolic syndrome in women

Sex hormones are involved in pathways of metabolic syndrome (MetS), an observation supported by animal studies. The relationships of sex hormones with components of MetS, such as insulin resistance and dyslipidemia, have been studied in pre- and postmenopausal women. High testosterone, low sex hormone-binding globulin, and low estrogen levels increase the risks of MetS and type 2 diabetes in women. Cutaneous diseases that are sex hormone mediated, such as polycystic ovary syndrome, acanthosis nigricans, acne vulgaris, and pattern alopecia, have been associated with insulin resistance and increased risk for MetS. Furthermore, inflammatory skin conditions, such as hidradenitis suppurativa and psoriasis, increase the risk for MetS. Patients with such skin conditions should be followed for metabolic complications, and early lifestyle interventions toward these populations may be warranted.

Metabolic Syndrome and Skin Diseases

The increasing prevalence of Metabolic syndrome (MetS) is a worldwide health problem, and the association between MetS and skin diseases has recently attracted growing attention. In this review, we summarize the associations between MetS and skin diseases, such as psoriasis, acne vulgaris, hidradenitis suppurativa, androgenetic alopecia, acanthosis nigricans, and atopic dermatitis. To discuss the potential common mechanisms underlying MetS and skin diseases, we focus on insulin signaling and insulin resistance, as well as chronic inflammation including adipokines and proinflammatory cytokines related to molecular mechanisms. A better understanding of the relationship between MetS and skin diseases contributes to early diagnosis and prevention, as well as providing clues for developing novel therapeutic strategies.

Clinical, Biochemical, and Hormonal Associations in Female Patients with Acne: A Study and Literature Review

Female acne is often associated with clinical signs of hyperandrogenism or metabolic syndrome. Various hormonal and biochemical factors as well as Vitamin D deficiency play a role in the etiopathogenesis of acne, and it is important to be able to detect the altered marker(s) indicative of certain abnormalities in order to diagnose and treat the cause. However, interpretation of these markers can be difficult, as there is ambiguity as to what is considered "normal" or "abnormal." The aim of this study was to explore the associations that acne might have with certain clinical, hormonal, and biological factors among female patients with acne. Additionally, the available literature was reviewed in order to determine the prevalence of these associations, discussion of which is provided. The author's investigations reveal a very high prevalence of abnormal metabolic and hormonal statuses among women with acne, indicating the need for dermatologists to maintain a high index of suspician for other disorders, especially metabolic disorders (and in particular, polycystic ovary syndrome), when treating female patients with acne.

Gynecologic and andrologic dermatology and the metabolic syndrome

The relationship of sex hormones to obesity and inflammation has been extensively studied. Research on endogenous and exogenous sex steroids, including studies on animal models of metabolic syndrome (MetS), has indicated that sex hormones are involved in metabolic pathways relevant to MetS. Lower testosterone levels in men and higher levels in women increase risks of MetS and type 2 diabetes mellitus (T2DM). Lower levels of sex hormone-binding globulin increase risks of MetS and T2DM in both sexes. Skin diseases that are sex hormone mediated, such as polycystic ovary syndrome, acanthosis nigricans, acne vulgaris, and pattern alopecia, have been associated with insulin resistance. Insulin resistance increases the risk for metabolic and potentially cardiovascular complications, and patients with such skin diseases should be followed for a prolonged time to determine whether they develop these complications. Early intervention may help delay or prevent the onset of T2DM and decrease cardiovascular risks.

Edible Plants and Their Influence on the Gut Microbiome and Acne

Acne vulgaris affects most people at some point in their lives. Due to unclear etiology, likely with multiple factors, targeted and low-risk treatments have yet to be developed. In this review, we explore the multiple causes of acne and how plant-based foods and supplements can control these. The proposed causative factors include insulin resistance, sex hormone imbalances, inflammation and microbial dysbiosis. There is an emerging body of work on the human gut microbiome and how it mediates feedback between the foods we eat and our bodies. The gut microbiome is also an important mediator of inflammation in the gut and systemically. A low-glycemic load diet, one rich in plant fibers and low in processed foods, has been linked to an improvement in acne, possibly through gut changes or attenuation of insulin levels. Though there is much interest in the human microbiome, there is much more unknown, especially along the gut-skin axis. Collectively, the evidence suggests that approaches such as plant-based foods and supplements may be a viable alternative to the current first line standard of care for moderate acne, which typically includes antibiotics. Though patient compliance with major dietary changes is likely much lower than with medications, it is a treatment avenue that warrants further study and development.

The possible role of diet in the pathogenesis of adult female acne

Acne in adults is a chronic, increasingly common disease, especially among women. It differs in pathogenesis and clinical presentation from adolescent acne. Acne in adults is associated with Western diet, defined as high consumption of milk, high glycemic load and high calorie intake. Metabolic signals of this diet result in a significant increase in insulin/insulin growth factor 1 serum level and consequently in the molecular interplay of mammalian target of rapamycin complex 1 kinase (mTORC1)/forkhead box protein 1 (FoxO1) mediated nutrient signaling, leading to increased proliferation of keratinocytes, increased lipogenesis and sebum production and finally to aggravation of acne.

Effects of isotretinoin on body mass index, serum adiponectin, leptin, and ghrelin levels in acne vulgaris patients

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.

Significance of diet in treated and untreated acne vulgaris

The relationship between diet and acne is highly controversial. Several studies during the last decade have led dermatologists to reflect on a potential link between diet and acne. This article presents the latest findings on a potential impact that diet can have on pathogenesis of acne vulgaris. The association between diet and acne can no longer be dismissed. Compelling evidence shows that high glycemic load diets may exacerbate acne. Dairy ingestion appears to be weakly associated with acne and the roles of omega-3 fatty acids, dietary fiber, antioxidants, vitamin A, zinc and iodine remain to be elucidated. The question of what the impact of diet is on the course of acne vulgaris still remains unclear.