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.