الفهرس 
Acknowledgements
OVERVIEW ON ACNE VULGARISOnly 14 pages are availabe for public view
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Abstract
Acne is a chronic skin disease of the PSU and it is one of the most frequently seen skin diseases in daily practice by Dermatologists. Acne is mainly caused by increased sebum secretions, ductal hypercornification, inflammatory cascades and bacterial participation. Although acne is seen at any age, it is most frequent in adolescents. Acne-gender relationship is variable.
Acne is not a simple skin disease, as it has many co-morbidities and can directly affect patients’ quality of life and psychosocial well-being. Previous studies have revealed that treating acne does have a positive impact on the patients’ quality of life.
Although many treatment modalities are currently available, treatment of acne is still a challenging and lengthy process.
Vitamin D has a number of functions in addition to its well-known role as a modulator of calcium metabolism and homeostasis. It affects both the innate and adaptive immune system. Moreover, it was found to be involved in many systemic inflammatory and dermatological diseases as atopic dermatitis, psoriasis, vitiligo, alopecia and acne.
The development of topical retinoids has proved to be a revolution in the management of acne. As such, Adapalene is important from a therapeutic perspective because of its proven efficacy and remarkable tolerability.
Our aim of this study was to evaluate serum Vitamin D levels in AV patients and to correlate its levels with patients’ demographic and clinical characteristics. Also, we aimed to assess the efficacy and safety of a topical Vitamin D analogue as a potential new therapeutic option of AV when compared with placebo and Adapalene.
This randomized controlled triple-blinded clinical trial was conducted in Assiut University Hospitals, Assiut, Egypt as a collaborative study between Dermatology, Venereology and Andrology Department and Clinical Pathology Department. A total 60 acne patients and 20 age and sex-matched apparently healthy volunteers were enrolled.
The 60 patients were divided into two groups (30 patients each): 1st group was treated by topical Vitamin D analogue (Calcipotriol) versus placebo (split face) and the 2nd group was treated by topical Adapalene (0.1%) versus topical Vitamin D analogue (split face).
Patients and controls were comparable in terms of age (p=0.21), gender (p= 1.00), residence (p= 0.78) and occupation (p= 0.8).
Regarding clinical data, we found that mild, moderate and severe grades of acne were present in 13 (21.7%), 31 (51.7%) and 16 (26.6%) patients, respectively. Mean disease duration was found to be 3.45 ± 1.55 months. Based on skin phototype, we found that 13 (21.7%), 36 (60%) and 11 (18.3%) patients had skin phototypes III, IV and V, respectively. We noticed that age, sex, disease duration and skin phototype had no significant relations with acne severity.
When we compared the BMI and its classes of patients with that of the controls, we could not detect any significant difference. Interestingly, we noticed that the majority of our patients (45%) were obese and (23.3%) were overweight. Moreover, we noted that patients with severe acne had significantly higher BMI (29.19 ± 3.28) when compared to those with mild grade (25.31 ± 5.59) and moderate grade (26.97 ± 4.82) (P< 0.001)
We noticed that patients had significantly lower Vitamin D levels in comparison to the control group (p< 0.001). Regarding the class of Vitamin D levels, we found that 43 patients (71.7%) had deficient levels. On the other hand, only 2 controls (10%) had deficient levels. This difference was significant (p=0.001). We found that patients with deficient levels of Vitamin D had significantly lower age (25.80 ± 3.68) in comparison to those with insufficient (28.32 ± 4.53) and sufficient levels (33.50 ± 4.50) (p=0.03). Noteworthy, we noticed that patients with severe acne had significantly lower Vitamin D levels (9.70 ± 5.74) in comparison to those with mild grade (16.47 ± 8.15) and moderate grade (15.33 ± 10.24) (p= 0.02). In addition, acne grade had a significant influence on different classes of Vitamin D levels (p= 0.03). All the 16 patients (37.2%) with severe acne had deficient Vitamin D levels.
By using photographic evaluation of the therapeutic responses, we found that patients who received Adapalene have significantly higher marked, excellent and complete improvement than the Calcipotriol and the placebo groups (p=0.001).
After treatment in group I, therapeutic response was significantly better on the side which was treated with topical Vitamin D analogue (p< 0.001). Also, classes of FASS showed significant improvement on the side which was treated with topical Vitamin D analogue (p< 0.001). Regarding percentage of change in FASS, there was a marked significant better reduction (p< 0.001) on the side which was treated with topical Vitamin D analogue when compared to the side which was treated with placebo. Moreover, patients reported a significant better satisfaction of the side which was treated with topical Vitamin D analogue (p< 0.001).
After treatment in group II, therapeutic response was significantly better on the side which was treated with topical Adapalene (p= 0.04). Also, classes of FASS showed significantly better improvement on the side which was treated with topical Adapalene (p= 0.03). Regarding percentage of change in FASS, there was a better significant reduction (p< 0.02) on the side which was treated with topical Adapalene when compared to the side which was treated with Vitamin D analogue (-23.65 ± 20.17). Moreover, patients showed a more significant satisfaction with the side which was treated with Adapalene (p=0.01).
A significant negative correlation between disease duration and therapeutic response in both patients’ groups was detected (p <0.001). However, we could not detect any significant influence of age, BMI and Vitamin D levels on the therapeutic outcomes in both patients’ groups.
Regarding the cutaneous side effects, percentages of redness, dryness and burning were significantly higher on the sides which were treated by Calcipotriol than the sides which were treated by Adapalene and placebo after one month. Interestingly, these significant values have become insignificant after two and three months of treatment.