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ORIGINAL ARTICLE |
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Year : 2022 | Volume
: 35
| Issue : 4 | Page : 1662-1667 |
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Evaluation of serum ghrelin in patients with acne vulgaris
Mohamed A Basha1, Maathir K El-Shafei2, Donya M. O. Boraey3
1 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt 2 Department of Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Menoufia, Egypt 3 Department of Dermatology, Andrology and STDs, Al-Minshawi General Hospital, Tanta, Egypt
Date of Submission | 23-Jul-2022 |
Date of Decision | 12-Aug-2022 |
Date of Acceptance | 22-Aug-2022 |
Date of Web Publication | 04-Mar-2023 |
Correspondence Address: Donya M. O. Boraey Elhelw Street, Algharbia, Tanta 43 Egypt
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/mmj.mmj_244_22
Objectives The aim of the study was to evaluate serum ghrelin in nonobese patients with moderate-to-severe acne vulgaris. Background Acne vulgaris is a multifactorial disease that affects mostly the adolescent population, but it is difficult to predict those who are prone to severe forms. Patients and methods A case–control study was conducted on 80 participants selected from the Dermatology Outpatient Clinic at Menoufia University Hospital during the period of study from March 2019 till December 2020. Full history taking and clinical and dermatological examinations were done. Serum ghrelin level was measured using the enzyme-linked immunosorbent assay. Results There was highly statistically significant difference between the two studied groups regarding serum ghrelin level. There was significant negative correlation between the severity according to The Global Acne Grading System with serum ghrelin level groups in terms of fasting glucose level, triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein. Conclusion There is a relationship between acne vulgaris and the level of ghrelin hormone, which is decreased in the serum of acne patients.
Keywords: acne, ghrelin, level, serum, vulgaris
How to cite this article: Basha MA, El-Shafei MK, Boraey DM. Evaluation of serum ghrelin in patients with acne vulgaris. Menoufia Med J 2022;35:1662-7 |
Introduction | | |
Acne vulgaris is a multifactorial disease that affects mostly the adolescent population, but it is difficult to predict those who are prone to severe forms. Acne vulgaris occurs on areas of the body with large sebaceous glands, including the face, cheek, nose, and forehead and also on the chest, upper back, and upper arms [1].
Although, acne does not cause any serious health threats as it is a self-limiting condition, it may cause significant psychological and social problems, depression, low self-esteem, disfigurement, and scarring that can persist for a lifetime [2].
The pathogenesis of acne is complex, with strong evidence supporting the involvement of follicular hyperkeratinization, hyperactivity of the sebaceous glands, colonization of Propionibacterium acnes and yeast, and associated inflammation [3].
Androgens increase the activity of sebaceous glands and sebum production and stimulate keratinocyte proliferation. Although the importance of androgens in the pathophysiology of acne has been supported by both clinical studies and experimental data, research evaluating ghrelin are very few in patients with acne vulgaris [4].
Ghrelin is a 28-amino acid acylated polypeptide hormone, mainly produced by the stomach cell, and it has paracrine and endocrine effects of multifunctional peptide hormones. Ghrelin increases growth, appetite, fat deposition, and gluconeogenesis [5].
In several studies, plasma ghrelin levels have been found to be lower in obese people and it has been recognized as one of the findings of metabolic syndrome, like hyperinsulinemia and insulin resistance [6].
The role of ghrelin in acne vulgaris is not exactly known, some studies have found that there is a difference in hormone levels among patients with acne vulgaris and controls, while some pointed out that there was no significant difference in the level of ghrelin hormone between the two groups. Further studies are necessary to make a comprehensive study on the relationship between acne vulgaris and ghrelin [7].
Oumoderate-to-severer study was aimed to evaluate serum ghrelin in nonobese patients with acne vulgaris.
Patients and methods | | |
The case–control study was conducted on 80 participants, comprising 40 patients with moderate-to-severe acne vulgaris in the age group of 18–30 years besides 40 healthy age-matched and sex-matched patients as a control group. All were selected from the Dermatology Outpatient Clinic at Menoufia University Hospital during the period of study from March 2019 till December 2020. The study was started after approval of protocol by the ethics committee of Menoufia University, Faculty of Medicine, Department of Dermatology, Andrology and STDs, Menoufia University. Nonobese patients with moderate-to-severe acne vulgaris, aged from 18 to 30 years were included in our study; while obesity, diabetes mellitus, hyperthyroidism or hypothyroidism, acute or chronic infection, polycystic ovary syndrome or amenorrhea, pregnancy, and systemic drugs were excluded from the study. Enrolled patients in the study were subjected to the following: full history intake: personal history (including name, age, sex, weight, height, waist–hip ratio, abdominal circumference). Present history (including onset, course, duration of the disease). Complete general examination including assessment of the BMI of patients with acne vulgaris and control groups. BMI is calculated by weight (in kilograms) divided by square of height (in meters): less than 18 kg/m2 are underweight, normal values ranged from 18 to 24 kg/m2, mild overweight values ranged from 25 to 29 kg/m2, moderate overweight values ranged from 30 to 34 kg/m2, and morbid overweight values ranged from 35 to 40 kg/m2 [8]. Dermatological examination including assessment of acne lesions using the Global Acne Grading Scale (GAGS) [9]; laboratory investigations: fasting blood glucose level was quantitatively measured using Trinder. GOD-POD (glucose oxidase-glucose peroxidase) using Spinreact (Spinreact, S.A.U. Santa Coloma, Spain). serum triglycerides (TGs) were determined by enzymatic colorimetric test for TGs using human kit, Germany [10]. Measurement of serum total cholesterol: Serum total cholesterol is determined by an enzymatic colorimetric test for cholesterol using human kit, Germany. Determination of serum high-density lipoprotein (HDL) cholesterol was determined using supplementary pack for use MPR1, MPR2 or MPR3 cholesterol kit from Boehringer Mannheim, Germany [11]. Determination of serum low-density lipoprotein (LDL) cholesterol was by the colorimetric method using biomerieux kit, France. The venous blood samples will be taken from patients and control groups after fasting for 10–12 h and centrifuged at 3000 rpm for 10 min. Serum samples will be divided into two tubes and kept frozen at − 80°C until used. One tube will be used for the assessment of lipid profile and fasting blood glucose, and the other tube will be used for measuring the serum ghrelin level by enzyme-linked immunosorbent assay (ELISA). Ghrelin (GHRELIN) level was measured by the ELISA technique, ELISA Kit (Catalog No.: 201-12-5583). The kit uses a double-antibody sandwich ELISA to assay the level of human Ghrelin (GHRELIN) in samples.
According to standards' concentration and the corresponding OD values, calculate out the standard curve linear regression equation, and then apply the OD values of the sample on the regression equation to calculate the corresponding sample's concentration. It is acceptable to use the kinds of software to make calculations. Written consent was performed from patients included in the study after explanation of it.
Statistical analysis
Data were fed to the computer and analyzed using IBM SPSS software package, version 20.0. (IBM Corp., Armonk, New York, USA). Qualitative data were described using numbers and percentages. Quantitative data were described using range (minimum and maximum), mean, SD, and median. The significance of the obtained results was judged at the 5% level. Analytical statistics were used to detect the possible correlation between the targeted disease and studied factors. The used tests of significance included, χ2 test was used to study the correlation between two qualitative variables; Student's t test was used for normally distributed quantitative variables, to compare between two studied groups. Pearson coefficient was used to correlate between two normally distributed quantitative variables. P value less than 0.05 was considered significant.
Results | | |
According to demographic data, we found that there was no statistically significant difference between the two studied groups regarding sex (P = 0.823), while there was highly statistically significant difference between the two studied groups regarding age (P < 0.001) [Table 1]. | Table 1: Comparison between the two studied groups according to demographic data and laboratory investigation
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The current study revealed that fasting glucose level was highly statistically significantly increased among the acne group than the control group, while there were no statistically significant differences between the two studied groups regarding TGs, total cholesterol, LDL, and HDL [Table 1].
In our study, we found that the mean onset and disease duration of the included patients were 15.30 ± 1.60 and 6.50 ± 2.78 years, respectively. Of the studied cases (57.5%) had a positive family history. The majority of cases had acne vulgaris in the face and body (62.5%). All cases had previous treatment. The mean severity GAGS was 28.48 ± 6.06; more than half of the studied cases (55%) had moderate acne vulgaris while 45% had severe acne vulgaris [Table 2]. | Table 2: Descriptive analysis of the studied cases according to onset and duration of disease, clinical data and severity Global Acne Grading System (n=40)
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As regards comparison between the two studied groups according to the serum ghrelin level, there was highly statistically significant difference between the two studied groups regarding serum ghrelin level [Table 3]. | Table 3: Comparison between the two studied groups according to serum ghrelin level
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Regarding correlation between severity GAGS and serum ghrelin level with laboratory results in the patient group, there was significant negative correlation between the severity GAGS with serum ghrelin level groups in terms of fasting glucose level, TGs, total cholesterol, LDL, and HDL [Table 4]. | Table 4: Relation between severity Global Acne Grading System and laboratory results in the patient group (n=40)
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In this study, fasting glucose level, TGs, total cholesterol, LDL, HDL, and serum ghrelin level were significantly increased between the moderate severity and severe severity groups [Table 5]. | Table 5: Correlation between severity Global Acne Grading System and serum ghrelin level with laboratory results in the patient group (n=40)
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Discussion | | |
Acne vulgaris is a multifactorial disease that affects mostly the adolescent population, but it is difficult to predict which individuals are prone to severe forms. Acne vulgaris occurs on areas of the body with large sebaceous glands, including the face, cheek, nose, and forehead and also on the chest, upper back, and upper arms [1].
Ghrelin is a 28-amino acid acylated polypeptide hormone, mainly produced by stomach cells and it has paracrine and endocrine effects of multifunctional peptide hormones. Ghrelin increases growth, appetite, fat deposition, and gluconeogenesis [5]. The role of ghrelin in acne vulgaris is not exactly known; some studies have found that there is a difference in hormone levels among patients with acne vulgaris and controls, while some pointed out that there was no significant difference in the level of ghrelin hormone between the two groups. Further studies are necessary to make a comprehensive study on the relationship between acne vulgaris and ghrelin [7].
Because of the decrease observed in the levels of these hormones which have antimicrobial features, that inflammation in acne cannot be suppressed and the reproduction of the microorganisms that play a role in the etiology of the disease cannot be prevented.
The current study showed that the mean onset and disease duration of the included patients were 15.30 ± 1.60 and 6.50 ± 2.78 years, respectively. Of the studied cases 57.5% had a positive family history. The majority of cases had acne vulgaris in the face and body (62.5%). All cases had previous treatment. This agreed with the study by Federman et al.[12] who found that acne can present as noninflammatory lesions, inflammatory lesions, or a mixture of both, affecting mostly the face but also the back and chest.
The present study showed that the mean severity GAGS was 28.48 ± 6.06; more than half of the studied cases (55%) had moderate acne vulgaris while 45% had severe acne vulgaris. This agreed with the study by Ozuguz et al.[13], who found that all of their patients had moderate acne vulgaris (GAGS 19–30). Also, the study by Shahbag [14] found that 29.17% patients had mild acne vulgaris, majority (41.6%) were moderate; 16.7% were severe, and 12.5% were very severe according to GAGS, which is a quantitative scoring system.
The present study showed that there was highly statistically significant difference between the two studied groups regarding serum ghrelin level. On the other hand, the study by Ozuguz et al.[13] found that there was no statistically significant difference of ghrelin level between nonobese patients with acne vulgaris and control groups.
The study by Cicek et al.[15] found that the mean serum ghrelin levels (27.58 ± 15.44 pg/ml) in patients with acne vulgaris was significantly lower than those of controls (35.62 ± 20.46 pg/ml) (P = 0.04). That ghrelin hormone is highly expressed in hair follicles and sebaceous glands of the skin and they found significantly lower serum ghrelin levels in patients with acne vulgaris, when compared with the controls. The insulin resistance of the patients was higher than the controls; however, it was not significant to explain low ghrelin levels. Thus, they could not correlate the decrease in ghrelin levels with insulin resistance, metabolic syndrome, or BMI. They thought that the level of ghrelin, a potent anti-inflammatory and antimicrobial peptide, could have decreased due to other mechanisms in an anti-inflammatory disease like acne vulgaris. Ghrelin produced in hair follicles and the sebaceous glands of the skin might participate in the pathogenesis of acne vulgaris and also acne vulgaris in humans might be associated with decreased serum ghrelin.
The current study revealed that fasting glucose level, TGs, total cholesterol, LDL, and HDL were significantly increased between the moderate severity and severe severity groups (P > 0.05), while the serum ghrelin hormone level was significantly decreased. This agreed with the study carried out by Emiroğlu et al.[16], who reported statistically significant differences with the control group with regard to BMI and fasting blood glucose. The Wen et al.[17] study revealed that plasma lipid profile (TG, HDL) in acne patients does not just increase, but that there are also many acne patients in whom lipid profile is higher or lower than normal.
On the other hand, the study by Balta et al.[18] found no statistically significant difference in TG and fasting blood glucose in different levels of disease severity (males or females). Another study by Ahmed et al.[19] found that there was no statistically significant difference in different levels of disease severity regarding plasma lipid profile (TG, HDL) between different patients (P < 0.05).
On the other hand, the study by Kanat et al.[20] found that ghrelin hormone mean values of mild, moderate, and severe groups were close to each other and were not statistically significant (P > 0.05).
Our study showed that there was significantly positive correlation between the severity GAGS with serum ghrelin level groups in terms of fasting glucose level, TGs, total cholesterol, LDL, and HDL. This agreed with the study by Rostami Mogaddam et al.[21] who found that there was a correlation between serum ghrelin level and severity of acne, and the results were statistically significant (P = 0.047). The serum ghrelin levels were lower in patients with moderate-to-severe acne compared with patients with mild acne.
Another study by Abdel Rahman and El Esaway [7] found that the mean serum level of ghrelin was significantly lower in patients compared with the control group, and acne severity had a significant effect on the level of ghrelin. Fasting glucose and TGs were significantly increased in the patient group compared with the control. Ghrelin hormone had a positive correlation to HDL and a negative correlation to LDL and insulin that the low level of ghrelin may predispose patients with postadolescent acne to hyperinsulinemia, type 2 diabetes, or dyslipidemia.
Conclusion | | |
There is a relation between acne vulgaris and the level of ghrelin hormone, which is decreased in the serum of acne patients.
Limitation of the study
Study on a large sample size is needed to confirm the effectiveness of our biomarkers; it makes a broad spectrum of results to ensure that serum ghrelin was used in the evaluation of nonobese patients with moderate-to-severe acne vulgaris.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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