الفهرس 
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Abstract
Summary
Acne vulgaris is the most common dermatological disease affecting up to 85 % of adolescents. There are many different local and systemic therapies are available for acne, treatment of acne can be challenging, also due to the fact that the pathophysiology of acne is not fully understood.
An important component of cutaneous innate immunity is the capability of resident and infiltrating cells to produce antimicrobial peptides (AMPs). AMPs have a wide-ranging activity against fungi, viruses and bacteria including Propionibacterium acnes (P. acnes). Furthermore, AMPs act as pro-inflammatory and chemo tactic signals hereby triggering innate and adaptive immune response.
Isotretinoin or 13-cis-retinoic acid (13-CRA) is a vitamin A derivative that is approved by U.S. Food and Drug Administration (FDA) for the treatment of severe nodulo-cystic acne. It is generally proposed that 13-CRA perform its biological action by being a precursor for all- trans-retinoic acid or 9-CRA isomers, which can adequately activate retinoic acid receptors and retinoid X receptors.
There are many factors which regulate sebaceous glands functions including androgen stimulation, vitamin D, and insulin-like growth factor one. Sebaceous follicles that have micro comedones provide an anaerobic and lipid rich environment which is optimum for P. acnes activity.
The effect of vitamin D is enhancement of innate immunity with complex regulation of adaptive immunity. Vitamin D regulates the immune system and the proliferation and differentiation of keratinocytes and sebocytes. Moreover, it has anti comedogenic and antioxidant effect. So, a vitamin D deficiency may facilitate the pathogenesis of acne. Vitamin D has been found to modulate lipid and cytokine production which recommend its possible role in acne pathophysiology.
Homocysteine is a sulfur-containing amino acid formed from methionine. It can be recycled into methionine via trans-methylation by means of cofactors such as folic acid and vitamin B12. Elevated Homocysteine levels have been shown to predispose patients to inflammation in the microcirculation by a combination of endothelial injury, inhibition of nitric oxide activity, stimulation of smooth muscle proliferation, vasoconstriction, platelet activation, and endothelium-leukocyte interactions.
Isotretinoin may also cause Hyper-Homocysteinemia due to its effects on cystathionine-β synthase, the enzyme responsible for Homocysteine metabolism. Previous studies have suggested that Isotretinoin therapy in acne patients affects plasma Homocysteine, folic acid, and vitamin B12 levels.
The aim of the study was to estimate the serum levels of Homocysteine and Vitamin D levels in patients with acne before and after receiving oral Isotretinoin. And if it correlate with the pathogenesis of acne.
This was a case control study that was conducted on 60 patients at Dermatology outpatient clinic at Beni-Suef University hospital from 1july 2021 to be continuing till 1 February 2022.
The results of our present study can be summarized as follows:
The current study showed a predominance of females (80.0%) than male (20.0%).
Our study showed that HCY was elevated from Mean ± SD (24.35) to mean ± SD (35.39) after the treatment with statistically significant difference found between Before and After.
Our study showed that Vitamin D was elevated from Mean ± SD (21.36) to mean ± SD (35.13) after the treatment with a highly statistically significant difference found between before and after.
Our results showed that there was highly statistically significant difference found between two groups regarding Vitamin D (ng/ml) Before.
Finally, it is concluded that there is an elevation of homocysteine HCY and Vitamin D levels in patients after isotretinoin therapy were found in this study and also evaluation of HCY and Vitamin D in acne patient were beneficial for the patients before they started isotretinoin treatment.