Acne Vulgaris is one of the most common chronic inflammatory skin diseases. It mainly affects adolescent and sometimes continues into adulthood, though may present at any age. For most patients, acne is characterized by the appearance of comedones, papules, pustules and nodules. Unfortunately, it may lead to permanent disfiguring scars. It primarily affects the face, neck, upper trunk and upper arms.
Acne is a multifactorial disease in which several factors have been implicated, including; hormonal effects, follicular hyperkeratinization, and proliferation of P.acnes, inflammatory, environmental and genetic factors.
Inflammation plays one of the main roles in the development of acne vulgaris. Both innate immunity and adaptive immunity especially the Th17 pathway may contribute significantly to the inflammatory response in acne. Following follicular rupture during acne lesion development, the release of P. acnes, sebum, and cellular debris into the dermis intensifies inflammation greatly. P. acnes have the capacity to contribute to the genesis of inflammatory acne via multiple pathways. Under these conditions, P. acnes or secreted cytokines may interact with immune cells within the dermis, also influencing Th17 development.
The cytokines involved in the differentiation of Th17 cells and the expression of the main effector cytokines IL-17A and IL-17F were found to be significantly expressed in lesions of acne.IL-17A and IL-17F are key cytokines for the recruitment and activation of neutrophils and can target different cell types to induce proinflammatory mediators.
This study included 40 patients suffering from AV. In addition to 40 apparently healthy individuals of matched age and sex as control group.
All studied individuals were subjected to complete history taking and complete clinical examination. All patients were selected from the outpatient clinic of Dermatology Department of Benha University Hospitals. Patients were graded into three groups; mild, moderate and severe cases according to GAGS. The study was approved by the local ethics committee on research involving human subjects of Benha Faculty of medicine. Informed consent was obtained from each individual before sample collection and investigation for serum IL-17 at Biochemistry Department Faculty of medicine Benha University.
Results of the present study showed a statistically significant difference regarding serum IL-17 level between studied patients and control groups. Serum level of IL-17 was high in severe cases of AV. Serum level of IL-17 was high in cases with acne scars suggesting that IL-17 may have a role in development of inflammatory lesions in AV patients .Morever, the present study results revealed that serum IL17 can be used in early diagnosis of AV when the cutoff point was ≥9.51pg/ml with high sensitivity 85%, specificity 60%, and accuracy rates 72.5%. Morever, it can be used as a prognostic marker for AV with high sensitivity in detecting severe cases, as sensitivity and specificity of IL17 serum level in patients with severe AV were 100% and 85.0% respectively with accuracy 88.5% when the cutoff point was ≥12.59 pg/ml.
In conclusion, serum level of IL-17 was higher in AV patients than controls. IL-17 is a mediator of inflammation which plays a role in pathogenesis of AV, associated with the susceptibility of development of AV and may be associated with the severity of the disease. Being elevated, it can be used for early diagnosis of the disease, indicating severity of the disease or used as a prognostic factor for development of acne scars.
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