|Year : 2020 | Volume
| Issue : 2 | Page : 160-163
Comparative analysis of serum lipid profile in adults with and without acne vulgaris in a tertiary care center in South India
Halaguru Narayanaswamy Veena, Kanathur Shilpa, Budamakuntla Leelavathy, Dammaningala Venkataramaiah Lakshmi
Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
|Date of Submission||31-Jan-2020|
|Date of Decision||15-Apr-2020|
|Date of Acceptance||19-May-2020|
|Date of Web Publication||18-Aug-2020|
No. 53, Department of Dermatology, Bangalore Medical College and Research Institute, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Acne is a chronic inflammatory disease of the pilosebaceous unit, affecting most teenagers during adolescence and at times may persist into adulthood also. Sebum analysis in some studies has shown increased triglycerides and wax/cholesterol esters in acne patients. Whether there is local alteration of surface lipids and seborrhea associated with any alteration of serum lipid profile in acne patients is not yet known. However, few studies in acne patients have shown definitive variations in lipid profile providing insights into plausibility of role of altered serum lipid levels in acne. Aims: The aim was to evaluate serum lipid profile in adults with and without acne vulgaris and to study the correlation between lipid profile and severity of acne in Indian patients. Materials and Methods: Fifty male and female adults presenting with acne aged between 18 and 40 years along with age- and sex-matched healthy adults without acne were subjected for serum lipid level analysis. Results: In this study, there was no significant difference in lipid levels in acne patients compared to control. Limitations: The limitation of the study was small sample size. Conclusions: There is no statistically significant increase in total cholesterol, very low-density lipoprotein, and low-density lipoprotein in acne patients compared to control.
Keywords: Acne, lipid profile, sebum
|How to cite this article:|
Veena HN, Shilpa K, Leelavathy B, Lakshmi DV. Comparative analysis of serum lipid profile in adults with and without acne vulgaris in a tertiary care center in South India. Clin Dermatol Rev 2020;4:160-3
|How to cite this URL:|
Veena HN, Shilpa K, Leelavathy B, Lakshmi DV. Comparative analysis of serum lipid profile in adults with and without acne vulgaris in a tertiary care center in South India. Clin Dermatol Rev [serial online] 2020 [cited 2021 Mar 4];4:160-3. Available from: https://www.cdriadvlkn.org/text.asp?2020/4/2/160/292479
| Introduction|| |
Acne is a common disorder, affecting most teenagers at some point of time or the other and is clinically characterized by seborrhea, open and closed comedones, papules, and pustules and in severe cases, nodules, deep pustules, and pseudocysts. Although excess sebum production is considered prerequisite for the development of acne, other factors involved in the pathogenesis include hypercornification of the pilosebaceous duct, colonization of pilosebaceous duct with Propionibacterium acnes, and local release of inflammatory mediators. Sebum analysis in some studies has shown increased triglycerides and wax/cholesterol esters in acne patients. However, is this local alteration of surface lipids and seborrhea associated with any alteration of lipid profile in acne patients? Alteration in the lipid profile of acne patients is not well known, but few studies in acne have shown some variations. However, literature search could not yield any such studies in Indian patients. Hence, this study was undertaken to evaluate lipid profile in Indian patients with acne.
| Materials and Methods|| |
Fifty male and female adults presenting with different grades of acne aged between 18 and 40 years, attending the Skin and STD-Sexually transmitted disease Outpatient Department of Victoria Hospital and Bowring and Lady Curzon Hospital affiliated to the Bangalore Medical College and Research Institute, from October 2015 to November 2017 and fifty adults who fulfilled the inclusion and exclusion criteria, as controls, were enrolled in the study after obtaining written informed consent. Acne patients willing to give consent for necessary blood investigations were included as cases. Pregnancy, lactation, females with clinical evidence of hirsutism, known familial hyperlipidemia, history of cardiovascular disease, smoking, alcohol, patient age group <17 years and >40 years, and obese with body mass index (BMI) >40.9 kg/m2 were excluded from the study as they could pose individual risk for altered lipid profile.
Age- and sex-matched fifty healthy adults without acne fulfilling the inclusion criteria of not having significant medical illness, not on any lipid-lowering medication, BMI – 18.5–24.9 kg/m2, and willing to give consent for necessary blood investigations were enrolled as controls. Acne patients were graded according to simple grading system proposed by the Indian authors [Table 1] and [Figure 1].
Both cases and controls were subjected to fasting serum lipid profile (total cholesterol, triglycerides, high-density lipoprotein [HDL], and low-density lipoprotein [LDL]). ATP III guidelines were followed for the reference range while analyzing serum lipids.
The Student's t-test and Chi-square test were used to compare the categorical data. P < 0.05 was considered statistically significant. All statistical analyses were performed using the SPSS software.
| Results|| |
With total sample size of fifty, 23 male and 27 female patients were enrolled in the study, and the age of the patients ranged from 18 years to 39 years; maximum age group affected was between 20 years and 24 years accounting for 62%. The mean age in this study was 22 years. All the fifty patients included were at the BMI range of 18.5–24.9 kg/m2.
The predominant acne grade was Grade II consisting of 37 patients (64%), followed by Grade III with 9 (18%) patients, 3 (6%) patients of Grade I, and 1 (2%) patient of Grade IV acne.
In this study, total cholesterol was low in 16% of cases as compared to 20% of controls. HDL was high in 26% of acne patients in comparison to 18% of controls. LDL was raised in 2% of acne patients compared to controls (0%). Very low-density lipoprotein (VLDL) was low in 16% of acne patients compared to 26% of controls. Triglyceride levels showed no variation in acne patients and controls [Table 2] and [Figure 2].
|Table 2: Lipid parameters' distribution in both groups of patients studied|
Click here to view
| Discussion|| |
Acne is a chronic inflammatory disease of the pilosebaceous unit, common dermatosis of concern in adolescence and adulthood. There is interplay between the puberty, with its rising androgen levels stimulating the sebaceous glands, and the inhibited outflow of sebum from the gland to the skin surface; this inhibited outflow occurs from a hyperkeratinization of the follicular epithelium in the pilosebaceous follicle. The earliest event in acne lesions formation appears to be change in the lower part of the follicular wall with the horny cells becoming stickier, causing impaction of these horny cells and dilatation of the sebaceous follicle. With this, a noninflammatory micronodule is born. This may stay as it is, it may enlarge into closed or open comedo, or it may go on to an inflamed acne such as a papule, pustule, nodule, or cyst from which scarring is likely.
The mosaic of events in acne vulgaris appears to be affected by various factors which include obesity, hormonal abnormalities, and immune-mediated mechanism, that potentiate the inflammatory response. The presence of excess adipose tissue which is maladaptive could induce lipid peroxidation, which affects the inflammatory processes of the innate immunity that are part of the response to acne vulgaris pathogenesis. It is known that bacterial hydrolases convert some of the triglycerides into free fatty acids on the skin surface; however, there is also evidence indicating that sebaceous glands can also synthesize considerable amounts of free fatty acids. Facial sebaceous glands are more sensitive to androgens. Androgens play an essential role in increasing the size of the sebaceous glands and stimulating sebum production as well as in stimulating keratinocyte proliferation in the ductus seboglandularis and the acroinfundibulum.,
The increase in the level of plasma cholesterol leads to an increase in androgen production, which, in turn, is a major predisposing factor for the onset of acne vulgaris.,
Several studies have reported that levels of HDL cholesterol are positively associated with endogenous levels of testosterone in men. Freedman et al. in their study have showed positive associations between testosterone and HDL cholesterol levels.
Androgens can stimulate sebum production through mechanisms: through androgen antagonism in the sebaceous glands, through inhibition of female gonadal hormone production by means of negative feedback, or through direct stimulation of lipid production.
Ola Ahmed Bakry et al. conducted a comparative study on nonobese, nonhirsute female adults with acne with age- and gender-matched healthy volunteers. Statistically significant difference between the mean value of plasma cholesterol, HDL cholesterol, LDL cholesterol, and Apo-A-1 was found between cases and controls.
Da Cunha et al. performed a study on the correlation of lipid levels with acne in female adults. This study showed a positive association between dyslipidemia and acne.
Akawi et al., who conducted a study on 271 patients aged between 13 and 42 years, showed that HDL-C level was significantly elevated in adults with different grades of acne. Early diagnosis can be an important measure for the prevention of metabolic syndrome in these adults. However, Vergani et al. did not find any significant difference in the triglyceride and total cholesterol levels between patients and controls.
In our study, total cholesterol was low in 16% of cases as compared to 20% of controls. HDL was high in 26% of acne patients on comparing to 18% of controls. LDL was raised in 2% of acne patients compared to controls (0%). VLDL was low in 16% of acne patients compared to 26% of controls. Triglyceride levels showed no variation in acne patients and controls.
| Conclusions|| |
In this study, there is no significant difference in the triglycerides and total cholesterol level between patients and controls. The causes of negative association are small sample sizes, less number of cases in Grade IV acne, racial difference, and acne with multifactorial etiology; dyslipidemia alone may not be a definite cause, rather a risk factor/compounding factor in causation and has a prominent role to play in hormonal acne/syndromic acne. To establish a correlation between the lipid profile and acne with more number of patients in Grade IV acne, further studies should be explored in the definite risk population like polycystic ovary syndrome and HAIR-AN syndrome.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kurokawa I, Danby FW, Ju Q, Wang X, Xiang LF, Xia L, et al
. New developments in our understanding of acne pathogenesis and treatment. Exp Dermatol 2009;18:821-32.
Pappas A, Johnsen S, Liu JC, Eisinger M. Sebum analysis of individuals with and without acne. Dermatoendocrinol 2009;1:157-61.
Adithyan B, Kumari R, Thappa DM. Scoring system in acne vulgaris. Indian J Dermatol Venerol Leprol 2009;75:323-6.
Abulnaja KO. Changes in the hormone and lipid profile of obese adolescent Saudi females with acne vulgaris. Braz J Med Biol Res 2009;42:501-5.
Rosenfield RL. Polycystic ovary syndrome and insulin-resistant hyperinsulinemia. J Am Acad Dermatol 2001;45:S95-104.
Zouboulis CC, Akamatsu H, Stephanek K, Orfanos CE. Androgens affect the activity of human sebocytes in culture in a manner dependent on the localization of the sebaceous glands and their effect is antagonized by spironolactone. Skin Pharmacol 1994;7:33-40.
Arora MK, Seth S, Dayal S. The relationship of lipid profile and menstrual cycle with acne vulgaris. Clin Biochem 2010;43:1415-20.
Akwai ZE, Latif NA, Razzak KA. The relationship between blood lipid profile and acne. J Health Sci 2007;53:596-9.
Freedman DS, O'Brien TR, Flanders WD, DeStefano F, Barboriak JJ. Relation of serum testosterone levels to high density lipoprotein cholesterol and other characteristics in men. Arterioscler Thromb 1991;11:307-15.
Westerveld HE, Hoogendoorn M, de Jong AW, Goverde AJ, Fauser BC, Dallinga-Thie GM. Cardiometabolic abnormalities in the polycystic ovary syndrome: Pharmacotherapeutic insights. Pharmacol Ther 2008;119:223-41.
Bakry OA, El Shazly RM, El Farargy SM, Kotb D. Role of hormones and blood lipids in the pathogenesis of acne vulgaris in non-obese, non-hirsute females. Indian Dermatol Online J 2014;5:S9-16.
Da Cunha MG, Batista AL, Macedo MS, Machado Filho CD, Affonso Fonseca FL. Study of lipid profile in adult women with acne. Clin Cosmet Investigational Dermatol 2015;8:449-54.
Vergani C, Finzi AF, Pigatto PD, Viogatti G, Nergi M, Altomare GF. Low level of HDL in severe cystic acne. N
Engl J Med 1982;307:1151-2.
[Figure 1], [Figure 2]
[Table 1], [Table 2]