The Efficacy of Oral Isotretinion in Reduction of Lipase Enzyme Activity of Cutibacterium acnes in Acne Vulgaris Iraqian Patients

Abstract

ABSTRACT: Background Acne vulgaris is one of the top three most common encountered dermatological problems worldwide in both primary and secondary care. A relation between acne vulgaris and Cutibacterium acnes(Propinoibacterium acnes) has long been suggested. A lipase enzyme secreted by this microorganism to metabolize sebum and the resulting metabolites evoke inflammation in human skin. The current study is conducted to assess the oral isotretinion treatment for acne vulgaris patients and understanding of C. acnes’ pathogenicity; via the lipase enzyme.Patients and Methods:50 patients with acne vulgaris seen in outpatient clinic of dermatology center in Baghdad during the period 1/9/2017 to 1/8/2018. The mean ages was 22±16-36 years. From the total of 50 patients,36(72%) of patients were females and 14(28%) were males. Furthermore 43(86%) of cases have previous family history of acne. Fifty samples from acne lesions were collected before oral isotretinion therapy, only forty-five samples were collected after oral isotretinion therapy. The diagnosis of patients were done by the specialist dermatologist, swabs and needle aspiration were collected from papules, pustules and nodulocystic lesions by the physician. The specimens were transported to the laboratory by using thioglycollate broth. The samples were cultured on Brucella blood agar with furazolidone in an anaerobic conditions, only C. acnes’ were grown. C. acnes isolates were cultured on spirit blue agar at 37 °C for 7days under anaerobic condition, to identify the lipase activity.Results: All isolates of C. acnes were lipase positive before oral isotretinion therapy. The degree of lipase enzyme significantly decreased after treatment with oral isotretinion in 44(98%) of isolates but 1(2%) of the cases was not. These results indicates that lipase was the common virulent enzyme which produced by C. acnes isolated that isolated from acne lesions. All of the clinical isolates were demonstrating strong lipase production before treatment .Conclusion: Great emphasis should be done on choosing the drug that is used to inhibit or decreases the sebum production and hyperkeratinization of pilosebaceous follicle unit activity rather than hypercolonization of C. acnes. So, using oral isotretionion will prevent the optimal environment conditions for the production of lipase by this bacterium, and subsequently oral isotretinoin therapy gives good improvement response.