Akne ve D Vitamini
Özet
Akne vulgaris, artmış sebum üretimi, foliküler hiperkeratinizasyon, Cutibacterium acnes (P. acnes) kolonizasyonu ve inflamasyon ile karakterize pilosebase ünitenin kronik inflamatuar bir hastalığıdır. Genellikle pübertede yüz, sırt ve göğüs bölgesinde yerleşen lezyonlarla seyretmekte, hafif komedonlardan ağır nodülokistik yapılara kadar değişen klinik tablolar sergilemektedir. Son yıllarda yapılan çalışmalar, bağışıklık sisteminin düzenlenmesinde, keratinosit ile sebositlerin çoğalması ve farklılaşmasında kritik roller üstlenen D vitamininin akne patogenezindeki etkisini ortaya koymaktadır. D vitamini, Th1 ve Th17 hücrelerinin proinflamatuar sitokin üretimini azaltırken, antiinflamatuar sitokinleri artırmakta, antikomedojenik ve antioksidan etkiler göstermektedir. Literatürdeki birçok klinik çalışma ve meta-analiz, akne hastalarındaki serum 25-hidroksivitamin D (25(OH)D) düzeylerinin sağlıklı kontrol gruplarına kıyasla anlamlı derecede düşük olduğunu ve eksikliğin hastalık şiddetiyle ilişkili olabileceğini göstermektedir. Yapılan sınırlı sayıdaki klinik araştırmada, D vitamini (kolekalsiferol veya alfakalsidol) takviyesi verilen akne hastalarının inflamatuar lezyonlarında gerileme ve sitokin seviyelerinde iyileşme gibi olumlu klinik sonuçlar saptanmıştır. Ancak coğrafi konum, beslenme ve güneşe maruz kalma gibi karıştırıcı faktörler nedeniyle çelişkili sonuçlar da mevcuttur. Sonuç olarak, akne yönetiminde D vitamininin standart bir tedavi rejimi olarak yer alması ve uygun dozajın belirlenmesi için daha geniş örneklemli ve çok merkezli klinik çalışmalara ihtiyaç duyulmaktadır.
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit characterized by increased sebum production, follicular hyperkeratinization, Cutibacterium acnes (P. acnes) colonization, and inflammation. It typically manifests during puberty with lesions located on the face, back, and chest, presenting clinical pictures that range from mild comedones to severe nodulocystic structures. Recent studies highlight the impact of vitamin D in acne pathogenesis, which plays a critical role in regulating the immune system and the proliferation and differentiation of keratinocytes and sebocytes. Vitamin D exhibits anticomedogenic and antioxidant effects while decreasing the pro-inflammatory cytokine production of Th1 and Th17 cells and increasing anti-inflammatory cytokines. Numerous clinical studies and meta-analyses in the literature demonstrate that serum 25-hydroxyvitamin D (25(OH)D) levels in acne patients are significantly lower compared to healthy control groups, and this deficiency may correlate with disease severity. In a limited number of clinical trials, positive clinical outcomes, such as a reduction in inflammatory lesions and improvement in cytokine levels, were observed in acne patients receiving vitamin D (cholecalciferol or alfacalcidol) supplementation. However, conflicting results also exist due to confounding factors such as geographical location, diet, and sun exposure. Consequently, comprehensive and multicenter clinical trials are required to incorporate vitamin D supplementation into standard acne treatment regimens and to determine the appropriate dosage.
Referanslar
Acharya P, Mathur M. Vitamin D deficiency in patients with acne vulgaris: A systematic review and meta-analysis Australas J Dermatol . 2020;61(1):e146-e149. Doi: 10.1111/ajd.13165.
Soyuduru G, Adışen E,Aksakal AB. Akne Vulgaris Patogenezi Güncel. Dermatoz;2017:1-9. Doi:10.15624.dermatoz17082d1.
Cong TX, Hao D, Wen X et.al. From pathogenesis of acne vulgaris to anti-acne agents. Archives of Dermatological Research. 2019; 311:337–349. Doi: 10.1007/s00403-019-01908-x.
Aksaç SE, Bilgili SG, Yavuz İH, Yavuz GÖ. Akne vulgariste etyopatogenez. Van Tıp Derg 2018;25(2):260-7. Doi: 10.5505/vtd.2018.85520.
Acar MA,Aksungur VL. Akne ve benzeri hastalıklar. Tüzün Y, Gürer MA, Serdaroğlu S, Oğuz O, Aksungur V (Editörler). Dermatoloji. 3.basım.2008:1189-216. Nobel Tıp Kitabevi, İstanbul.
Knutsen-Larson S, Dawson AL, Dunnick CA, Dellavalle RP. Akne vulgarisalle RP. Acne Vulgaris: Pathogenesis, Treatment, and Needs Assessment. Dermatol Clin. 2012;30(1):99-106. Doi: 10.1016/j.det.2011.09.001.
Bhat YJ, Latief I, Hassan I. Update on etiopathogenesis and treatment of Acne. Indian J Dermatol Venereol Leprol. 2017;83(3):298-306. Doi: 10.4103/0378-6323.199581
Platsidaki E, Dessinioti C. Recent advances in understanding Propionibacterium acnes ( Cutibacterium acnes) in acne F1000Res. 2018;7:F1000 Faculty Rev-1953. Doi: 10.12688/f1000research.15659.1
Dréno B. What is new in the pathophysiology of acne, an overview J Eur Acad Dermatol Venereol. 2017;31 Suppl 5:8-12. Doi: 10.1111/jdv.14374
Topan AE, Şavk E, Karaman G et.al. Akne vulgaris patogenezinde D vitamini ve interlökin-17’nin rolünün değerlendirilmesi. Turkderm2019;53:68-72. Doi:10.4274/turkderm.galenos.2018.81236
Kistowska M, Meier B, Proust T et. al. Propionibacterium acnes Promotes Th17 and Th17/Th1 Responses in Acne Patients. Journal of Investigative Dermatology. 2015; 135: 110–8. Doi: 10.1038/jid.2014.290. Epub 2014 Jul 10.
Agak GW, Qin M, Nobe J et.al. Propionibacterium acnes induces an interleukin-17 response in acne vulgaris that is regulated by vitamin A and vitamin D. J Invest Dermatol. 2014; 134(2): 366–73.
Corvec S,, Dagnelie MA, Khammari A, Dréno B. Taxonomy and phylogeny of Cutibacterium (formerly Propionibacterium) acnes in inflammatory skin diseases. Ann Dermatol Venereol. 2019;146(1):26-30. Doi: 10.1016/j.annder.2018.11.002.
Çiftçi N. D Vitamini Düzeylerinin Deri Hastalıkları Üzerine Etkisinin Retrospektif Değerlendirilmesi. Kocaeli Med J 2018; 7: 3:47-54 .
Navarro-Triviño FJ, Arias-Santiago S, Gilaberte-Calzada Y. Vitamin D and the Skin: A Review for Dermatologists. Actas Dermosifiliogr 2019 May;110(4):262-272. Doi: 10.1016/j.ad.2018.08.006.
Mostafa WZ, Hegazy RA. Vitamin D and the skin: Focus on a complex relationship: A review Journal of Advanced Research. 2015; 6: 793–804.Doi: 10.1016/j.jare.2014.01.011.
Yavuz D, Yavuz R, Altunoğlu A. D Vitamini, Kalsiyum & Mineral Metabolizması, D Vitaminin İskelet Dışı Etkileri ve Kronik Böbrek Yetmezliğinde Nutrisyonel D Vitamini Kullanımı Ankara Med J, 2014; 14(4): 162-71. Doi: 10.17098/amj.19812.
Thiboutot DM, Layton AM, Eady EA. IL-17:a key player in the P. acnes inflammatory cascade? J Invest Dermatol. 2014;134:307-310. Doi: 10.1038/jid.2013.400.
Kelhälä HL, Palatsi R,Fyhrquist N et al. IL-17/Th17 pathway is activated in acne lesions. PLoS One.2014 25;9: e105238 Doi:10.1371/journal.pone.0105238
Agak GW, Kao S, Ouyang K et.al. Phenotype and Antimicrobial Activity of Th17 Cells Induced by Propionibacterium acnes Strains Associated with Healthy and Acne Skin. J Invest Dermatol 2018;138(2):316-24. Doi:10.1016/j.jid.2017.07.842.
Alhetheli G, Elneam AIA, Alsenaid A, Al-Dhubaibi M. Vitamin D Levels in Patients with and without Acne and Its Relation to Acne Severity: A Case-Control Study. Clinical, Cosmetic and Investigational Dermatology 2020:13 759–65. Doi: 10.2147/CCID.S271500.
Lee WJ, Choi,YH, Sohn MY et al. Expression of Inflammatory Biomarkers from Cultured Sebocytes was Influenced by Treatment with Vitamin D. Indian J Dermatol. 2013; 58(4): 327. Doi: 10.4103/0019-5154.113959.
Mehta-Ambalal S. Clinical, Biochemical, and Hormonal Associations in Female Patients with Acne: A Study and Literature Review J Clin Aesthet Dermatol. 2017;10(10):18-24.
Kramer C , Seltmann H , Seifert M et.al. Characterization of the vitamin D endocrine system in human sebocytes in vitro J Steroid Biochem Mol Biol. 2009;113(1-2):9-16. Doi: 10.1016/j.jsbmb.2008.10.010.
Kemeriz F, Tuncer SC, Acar EM, Tuğrul M. Evaluation of 25-hydroxy vitamin D levels and disease severity in patients with acne vulgaris. Dermatol Ther. 2020;33(3):e13393. Doi: 10.1111/dth.13393
Abd-Elmaged WM, Nada EA, Hassan MH et.al. Lesional and circulating levels of interleukin-17 and 25-hydroxycholecalciferol in active acne vulgaris: Correlation to disease severity. J Cosmet Dermatol 2019;18(2):671-6. Doi:10.1111/jocd.12715
Yildizgören MT, Togral AK. Preliminary evidence for vitamin D deficiency in nodulocystic acne. Dermatoendocrinol. 2015; 14:6(1):e983687. Doi: 10.4161/derm.29799.
Al-Taiar A, AlKhabbaz M, Rahman A et.al. Plasma 25-Hydroxy Vitamin D is not Associated with Acne Vulgaris. Nutrients. 2018;10(10):1525. Doi: 10.3390/nu10101525.
Toossi P, Azizian Z, Yavari H et. al. Serum 25-hydroxy vitamin D levels in patients with acne vulgaris and its association with disease severity. Clin Cases Miner Bone Metab. 2015; 12(3): 238–42. Doi:10.11138/ccmbm/2015.12.3.238.
El-Hamd MA, El Taieb MA, Ibrahim HM, Aly SS. Vitamin D levels in acne vulgaris patients treated with oral isotretinoin. J Cosmet Dermatol. 2019;18(1):16-20.Doi: 10.1111/jocd.12503.
Karabay EA, Çerman AA. Serum Levels of 25-Hydroxyvitamin-D and C-Reactive Protein in Acne Vulgaris Patients. Turkiye Klinikleri J Dermatol. 2019;29(1):1-6. Doi: 10.5336/dermato.2018-63846.
Wang M, Zhou Y, Yan Y. Vitamin D status and efficacy of vitamin D supplementation in acne patients: A systematic review and meta-analysis. J Cosmet Dermatol 2021 Mar 10. Doi: 10.1111/jocd.14057.
Lim SK, Ha JM, Lee YH et. al. Comparison of Vitamin D Levels in Patients with and without Acne: A Case-Control Study Combined with a RandomizedControlledTrial.PLoSOne. 2016;11(8):e0161162. Doi:10.1371/journal.pone.0161162
Ahmed Mohamed A, Salah Ahmed EM , Abdel-Aziz RT et al. The impact of active vitamin D administration on the clinical outcomes of acne vulgaris. J Dermatolog Treat. 2020;1-6. Doi: 10.1080/09546634.2019.1708852
