الفهرس | Only 14 pages are availabe for public view |
Abstract Acne is currently understood as a chronic inflammatory disease of the pilosebaceous unit, characterized by androgen-induced increased sebum production, follicular hyperkeratinization, inflammation and altered adaptive immune response. Bacterial colonization by propionibacterium acnes definitely aggravates the course of the disease in various manners, but its role as prerequisite of the induction of acne is disputable. The clinical features of acne include seborrhea (excess grease), non-inflammatory lesions (open and closed comedones), inflammatory lesions (papules and pustules), and various degrees of scarring. Nodules and cysts comprise severe nodulocystic acne. The distribution of acne corresponds to the highest density of pilosebaceous units (face, neck, upper chest, shoulders, and back). Grading the severity of acne as mild, moderate or severe is a useful initial assessment. Mild disease comprises open and closed comedones with sparse inflammatory lesions. In moderate acne, papules and pustules are more numerous. Severe acne comprises extensive lesions, and may include nodules and scarring. The presence of higher androgen levels is important for the development of acne lesions. However, the majority of acne patients exhibit normal levels of circulating androgens, suggesting that the impact of androgens on the development of acne lesions might be related to endorgan sensitivity. The ratio of second to fourth digit length (2D:4D) has been hypothesized to reflect prenatal androgen exposure and an individual’s sensitivity to androgens. Men have a longer fourth digit (ring finger) relative to the second digit (index finger) than women. Exposure to higher androgen levels through the prenatal period is related to a lower 2D:4D ratio in both sexes. For instance, lower 2D:4D (male type) digit ratios were found in both females and males with congenital adrenal hyperplasia compared with healthy same-sex controls. Higher (female type) digit ratios are also found in XY males with androgen insensitivity syndrome, and this may be an indicator of their importance of end-organ sensitivity. Prenatal androgen levels increase at the end of the first trimester and affect a number of organ systems. The prenatal androgen peak time period (between 13 and 15 weeks of gestation) coincides with both the development of the sebaceous gland and digits giving the idea to investigate the relationship between digit ratio and acne vulgaris. In this study, we aimed to evaluate second and fourth digit length ratio (2D:4D) in acne vulgaris patients compared to controls, and to assess the association of this ratio with clinical aspects (duration, severity and age of onset) of that disease. The current study was carried out on 521 patients with different degrees of acne vulgaris severity selected from Dermatology outpatient clinic, Faculty of Medicine, Menoufia University Hospital, Mansoura Dermatology Hospital and during the period from january2015 to December 2015, in addition to 231 age and sex matched healthy volunteers as a control group. For all participants through history taking, good general and dermatological examination and second and fourth digit length measurement were done. Age of acne patients(521)ranged from 16 to 26 years with a mean age of 19.87± 4.487 years, while age of control subjects ranged from 16 to 36 years with mean age of 19.54 ± 3.809 years. There were 352 females and 169 males. The control group included 63 males and 168 females. Statistically, there were non-significant differences between patients and controls as regards to age and sex distribution. Clinical severity of all acne cases, varied from mild (64 cases,12.3%), moderate (344cases ,66%) to severe 113 cases, 21.7%). Male cases severity varied from mild (22 cases,13%), moderate(121 cases,71.6%) and severe (26 cases ,15.4%)., while in females cases severity varied from mild (42 cases, 11.9%), moderate (223cases, 63.4%) to severe (87 cases, 24.7%). In our study, there were no significant differences between right digit 2D:4D ratio, left digit 2D:4D ratio and total digit 2D:4D ratio in male patients and control subjects; however, female acne patients showed significantly lower right digit 2D:4D ratio, left digit 2D:4D ratio and total digit 2D:4D ratio when compared to their control females. In male acne patients, there was significant positive correlation between severity of acne lesion and right 2D:4D ratio, but insignificant correlations were found regarding left and total 2D:4D digit ratio. There were significant negative correlations between right, left and total 2D:4D ratio with disease duration.Concerning the age of acne onset, no significant correlations were found between right, left or total 2D:4D and age of onset of acne lesion. In female acne patient group, there was significant negative correlation between right, left and total 2D:4D digit ratio with disease duration. Significant positive correlations reported between left and total 2D:4D digit ratio with severity of acne (p<0.001, r=0.481; P<0.001, r=0.197). No significant correlations were found between right (P=0.223,r=-.0.065) 2D:4D ratio in female patients with acne severity. Concerning age of onset in acne development, no significant correlations could be detected between any of assessed digit 2D:4D ratio (right, left and total) with age of onset of acne (p= 0.169,r=- 0.073; p=0.121, r=0.083 &p=0.874 ,r= -0.008) respectively. |