Introduction
Acne is a common chronic inflammatory disease of the pilosebaceous unit.
Four key factors play a role in pathogenesis with interrelated
mechanisms, such as increased sebum production, hyperkeratinization of
the follicular infundibulum, inflammation, and Cutibacterium
acnes proliferation. Primary lesion types in acne are comedones and
inflammatory lesions (papules, pustules, and nodules). The typical
distribution of acnes includes the face, upper back, chest, and
shoulders rich in sebaceous glands. The treatment approach can vary
depending on the type, distribution, severity, and degree of effect on
the patient.1
Isotretinoin (ISO) is a synthetic analogue of vitamin
A2. ISO treatment is effective in all four steps of
acne pathogenesis.2 However, it has numerous side
effects related to many systems such as hepatic, renal, musculoskeletal,
hematological, neuropsychiatric, and gastrointestinal systems. Also,
some conflicting publications have been reported on its relationship
with some inflammatory diseases such as inflammatory bowel disease and
sacroiliitis.2-4 In clinical practice, patients are
followed up with laboratory tests such as complete blood count (CBC),
liver and kidney function tests, and lipid profile.
Mean platelet volume (MPV) and plateletcrit (PTC) indicate the platelet
function and percentage of platelet volume in the blood; respectively.
MPV, PTC, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte
ratio (PLR) were used as inflammatory markers in various studies for
many diseases and drugs, including ISO treatment.5-7Monocyte to high-density lipoprotein ratio (MHR) is a recently defined
inflammatory biomarker associated with metabolic syndrome and
atherosclerosis.6,8 Separate studies have reported an
increase in MHR and carotid intima-media thickness (CIMT) in acne
patients after ISO treatment.9,10 Although ISO is
known to predispose to hyperuricemia, there is not enough clear
information in the literature about the mechanism of triggering the
increase in serum uric acid (SUA) level.11 Lately,
some studies emphasize that hyperuricemia is a risk factor for both
metabolic syndrome and cardiovascular diseases (CVD), which is also
associated with values such as MHR and PLR.6,12,13 In
a recent study consisting of more than 8000 participants was reported
for the first time in the literature that MHR has a positive correlation
with SUA and that it can be used in predicting the risk stratification
of hyperuricemia.14
In this study, we aimed to reveal the relationship of uric acid with MHR
and other inflammatory markers stated above, in moderate-severe acne
patients before and after ISO treatment. In this way, we can try to shed
light on the frequently reported relationship between ISO treatment and
atherosclerosis.