Isotretinoin Induced Hyperlipidemia and Impact of Leptin


Introduction

Acne vulgaris (AV) is a chronic inflammatory disease that affects the pilosebaceous unit of the skin in vast majority of adolescents. It is a multifactorial disease with underlying altered keratinization, increased sebum secretion, colonization of Propionibacterium acnes, and dermal inflammation.1 AV is a common skin disease that affects approximately 9.4% of the world’s population with the highest prevalence in adolescents. It affects over 90% of males and 80% of females in all ethnic groups.2,3 The prevalence of acne in adolescents and adults differs among countries and ethnic groups.4 In Egypt, 60% of female students in secondary school reported AV5 and high prevalence of acne among adolescent females was observed.2,5

Although acne is linked to pubertal androgen surge at the beginning, it is more related to growth hormone and insulin-like growth factor-1 (IGF-1) during its course.6,7

IGF-1, a 7.5 kDa single chain polypeptide, is a major homeostatic regulator of many physiological, anabolic, and metabolic processes.8 IGF-1 exerts its comedogenic effect by stimulating the proliferation of sebaceous glands and lipogenesis through potentiation of adrenal androgen and peripheral androgen signaling at the receptor level.9,10

A positive correlation is observed between IGF-1 level and sebum secretion which is reflected on severity of AV.6,11 IGF-1 increases expression of element‐binding protein‐1, which stimulates lipogenesis in sebocytes. IGF‐1 transmits its lipogenic signal through activation of the phosphoinositide 3‐kinase/Akt pathway.10,12

The adipose tissue is not only energy storage, but it also has endocrinological and immunological functions through the secretion of bioactive mediators called adipokines.13,14 One of these is Leptin (LEP), which is encoded by the LEP gene. It controls lipid and sugar metabolism, thus playing a vital role in energy consumption and appetite pathway.15

LEP gene polymorphisms is associated with high risk…



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