Evaluation of subclinical atherosclerosis in patients with acne vulgaris treated with systemic isotretinoin

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. It usually occurs between the ages of 11-30, with a rate of 85%. Isotretinoin, an active retinoic acid derivative, is the most effective and remission-long drug in acne treatment. It is used in severe acne, moderate acne which is resistant to other treatments and scar prone acnes. Coronary artery disease is one of the main reasons of mortality and morbidity in the world and atherosclerosis plays a major role in the development of coronary artery diseases. In studies with isotretinoin; triglyceride, total cholesterol and low density lipoprotein levels have been shown to be increased while high density lipoprotein levels be in decreasing pattern so it could be said that isotretinoin may cause atherosclerosis indirectly. However; there are only few studies reporting the relationship between long-term use of isotretinoin and the risk of atherosclerosis in the literature. The aim of this study was to determine how the systemic use of isotretinoin in the treatment of moderate to severe acne vulgaris in dermatology clinics affects subclinical atherosclerosis by using sensitive parameters indicating the presence of subclinical atherosclerosis. Our study was completed with 63 acne vulgaris patients treated with isotretinoin for six months. Glucose, insulin, lipid profile, lectin-like oxidized low-density lipoprotein receptor-1, high-sensitivity C-reactive protein and oxidized low-density lipoprotein values were compared at the beginning and at the end of treatment. Of these patients, 84.1% (n=53) were female and 15.9% (n=10) were male. In the post treatment, low-density lipoprotein, very low-density lipoprotein, lectin-like low-density lipoprotein receptor-1, triglyceride, total cholesterol and aspartate aminotransferase levels were found to be increased and statistically significant (p<0.001). In the post-treatment, oxidized low-density lipoprotein levels were found to be increased and statistically significant (p=0.040). There was no statistically significant difference in high sensitivity C-reactive protein level (p=0.458). In post-treatment, there was a statistically significant increase in lectin-like oxidized low density lipoprotein receptor-1 levels in both males and females (p<0.001). In the pre-treatment, it was observed that lectin-like oxidized low-density lipoprotein receptor-1 level was higher in males than females and statistically significant (p=0.028). In the post-treatment, it was observed that lectin-like low-density lipoprotein receptor-1 levels were higher in males than females and statistically significant (p<0.001). There was a positive correlation between waist circumference and LOX-1 values (r=0.274, p=0.030). The cut-off value for waist circumference was 69.25 cm. In conclusion, the results of our study suggest that isotretinoin causes subclinical atherosclerosis. It has been found that the risk of subclinical atherosclerosis is higher in male population than females. Although the number of subjects in our study is limited, based on our data, as the waist circumference gets larger, the risk of atherosclerosis also increases. The people with high cardiovascular risk factors and large waist circumference should be cautious about the risk of atherosclerosis during isotretinoin use.