Serum level of Apelin-12 in acne patients: Is it a marker of disease severity?

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Eman Youssef, Marwa Gaber, Amira Mohammed, Doaa About-Taleb This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6214265/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 19 You are reading this latest preprint version Abstract Background Acne vulgaris (AV) is a common inflammatory skin condition often associated with metabolic and hormonal factors. Our aim to assess the role of serum apelin-12 in acne and its correlation with body mass index (BMI), insulin resistance (IR) and acne severity. Patients and Methods: Ninety individuals were included in this case control study, comprising 60 acne patients and 30 age and sex matched healthy controls. Detailed history was taken. Clinical evaluations included BMI, waist circumference, and assessment of acne severity using the Global Acne Grading Scale (GAGS). Laboratory tests measured serum fasting blood glucose (FBG), fasting insulin, serum apelin-12 and complete lipid profile. Insulin resistance (IR) was assessed using HOMA-IR. Results Acne patients had significantly higher serum apelin-12 levels (121.36 ± 51.63) compared to controls (73.48 ± 18.98) (p = 0.000*). Apelin-12 level increased with acne severity assessed by GAGS and was positively correlated with BMI, FBG, fasting insulin level and HOMA-IR. Triglycerides (TG), cholesterol and low-density lipoprotein (LDL) levels were also higher in acne patients compared to controls, while high-density lipoprotein (HDL) levels were lower. A significant association was found between acne severity and IR, suggesting that IR plays a crucial role in the pathogenesis of AV. Conclusion This study suggests serum apelin-12 as a potential marker for acne severity, with its level correlated with BMI, IR and the inflammatory state of acne. The significant correlation between acne severity and IR highlights the importance of managing IR in treatment of acne. Acne vulgaris apelin-12 insulin resistance BMI GAGS lipid profile inflammation Figures Figure 1 Figure 2 Introduction The growth of non-inflammatory open and closed comedones as well as inflammatory papules, pustules, nodules, and cysts are the hallmarks of acne vulgaris (AV), a prevalent chronic inflammatory illness of the pilosebaceous unit. 1 Acne can progress to build scarring and become refractory purulent cysts, nodules, and subcutaneous fistulas that are resistant to treatment. Since sebaceous follicles are more prevalent on the face, neck, chest, and upper back, these areas are where it most frequently appears. It typically first manifests itself after puberty and can last until 40 or 50 years of age. 2 Even though AV is one of the most prevalent dermatological conditions, it has a significant detrimental impact on psychological functioning. Acne has been linked to increased rates of anxiety, despair, and inability to function in social situations. 3 Numerous studies have indicated that nutrition may have an impact on the pathophysiology of acne. Additionally, it has been demonstrated that in young individuals with AV, a low glycemic index diet improved both the severity of their acne and their insulin sensitivity at the same time. Consequently, the genesis and severity of acne may be influenced by insulin and the metabolism of carbohydrates. 4 Adipokines might be involved in the AV pathogenesis. In nonobese patients with moderate AV, leptin, adiponectin, ghrelin, and insulin resistance (IR) might not be involved in the underlying causes. 5 Apelin is a 36-amino acid peptide that is generated in particular hypothalamic neurons as a portion of a 77-amino acid prepropeptide precursor. It appears that apelin receptor (APJ), a single G protein-coupled receptor subtype, mediates its effects. 6 Apelin and APJ mRNA are recognized as important regulators of central and peripheral responses to numerous homeostatic perturbations. They are expressed in the brain, pituitary gland, heart, lung, adipose tissue, and gastrointestinal tract, among other organs. 7 The aim of the study is to detect the level of serum apelin-12 in acne and its correlation with body mass index (BMI), IR and acne severity assessed by Global Acne Grading Scale (GAGS). Patients and Methods Study design and population This prospective case control study was performed at the Dermatology Department and Medical Biochemistry Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Our study was approved by the Research Ethics committee of Faculty of Medicine Assiut University (Approval number IRB 17100444) and it was carried out in accordance to the Helsinki Declaration guidelines. All participants gave their informed consent before enrollment in the study. A total of ninety individuals were included in the study, sixty acne patients with mild, moderate and severe acne lesions were randomly recruited and enrolled in the study. Thirty healthy age and sex matched individuals were enrolled in the study as controls. The exclusion criteria included: Pregnancy, lactation, patients with any systemic diseases as diabetes mellitus, renal failure and liver failure. Those having dermatological diseases other than acne vulgaris or having any systemic inflammatory diseases. Also, those receiving medications known to affect adipokines level (as oral retinoids and hypolipidaemic drugs) and hormonal treatment like oral contraceptive pills as it will positively influence the development of acne. The participants were divided into two groups: Study group: included sixty patients with active acne and control group: included thirty healthy individuals. Methods A detailed history was taken from each patient including name, age, sex, occupation, residence, marital status, disease onset, course, duration, previous treatment and its efficacy and family history of acne. General clinical examination was done to exclude any systemic diseases. Clinical evaluation included measuring waist circumference and calculating BMI. BMI was calculated as weight in kilograms divided by height in meters. A BMI of 18.5 to 24.9 is considered normal (non-obese), 25 or higher (overweight), and 30 or higher (obese). A full dermatological examination was performed to assess acne severity using the GAGS and to detect any additional skin conditions. Laboratory Analysis Five milliliters of peripheral venous blood was withdrawn from each patient and control after 10–12 hours of fasting. The blood samples were allowed to clot completely (within 2 hours) at the room temperature. Centrifugation was done at 1000×g. for 20 minutes to separate the serum. After centrifugation, serum was separated by a pipette, divided and kept in one eppendorf tube labeled with the patient number. Specimens were kept at 20°C to preserve until the time of the run, avoiding repeated freeze-thaw cycles. Sampling for FBG was determined at once. Laboratory assessment included serum fasting blood glucose (FBG) level, serum fasting insulin level, IR, serum level of apelin-12 by enzyme-linked immunosorbent assay (ELISA) technique and serum complete lipid profile (Cholesterol, triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL). Assessment of serum FBG level: Measurement of serum glucose was done using Glucose Assay Kit, applied by Abnova company (CAT: KA1648). Samples were run on device (DAS Plate reader, SN 2006, Italy). Measurement of serum fasting insulin level: Measurement of serum insulin was done using Human Insulin ELISA Kit, (CAT: 90095) Crystal Chem, USA. Samples were run on ELISA device (DAS Plate reader, SN 2006, Italy). Assessment of IR: IR was calculated in all participants in the study via measuring of fasting serum insulin and FBG levels and calculated by HOMA-IR. HOMA-IR= [Fasting glucose (mmol/L) x Fasting serum insulin (mIU/L)] ÷ 22.5. Normal value is below 2.5. Assessment of serum level of apelin-12: Serum apelin-12 levels were determined by ELISA (Human APLN (apelin-12) ELISA Kit Elabscience). Intra- and inter-assay CVs were 5%, and 14%, respectively. Statistical analysis Data entry and analysis were done using SPSS version 22 (Statistical Package for Social Science). Data were presented as number, percentage, mean, standard deviation (SD), median and range. Chi-square test and Fisher Exact test were used to compare between qualitative variables. In case of parametric data, Independent samples t-test was used to compare quantitative variables between two groups and ANOVA/ Post-hoc (LSD) test for more than two groups. Pearson correlation was done to measure correlation between quantitative variables. While in case of non-parametric data, Mann-Whitney test was used to compare quantitative variables between two groups and Kruskal Wallis Test for more than two groups. Spearman correlation was done to measure correlation between quantitative variables. Medcalc was used to calculate sensitivity, specificity, positive and negative predictive values and receiver operating characteristic (ROC) curve. P-value was considered statistically significant when P-value < 0.05. Results This study involved 90 participants consisting of 60 acne patients and 30 age and sex matched healthy controls. The mean of age in acne patients ± SD was (20.08 ± 2.75) and ranged from 15 to 27 years old, with a gender distribution of 44 females (73.3%) and 16 males (26.7%). Comparison between the two study groups revealed that there was no statistical significant difference regarding age, sex, residence, occupation and marital status (p-values > 0.05), as shown in (Table 1 ). Table 1 Demographic data of the study participants. Personal data Patients (n = 60) Controls (n = 30) P-value n % n % Age: (years) Mean ± SD 20.08 ± 2.75 21.17 ± 2.90 0.087 Range 15.0–27.0 17.0–26.0 Sex Male 16 26.7% 7 23.3% 0.733 Female 44 73.3% 23 76.7% Residence Urban Rural 38 22 63.3% 36.7% 16 14 53.3% 46.7% 0.361 Marital status Single 58 96.7% 29 96.7% 1.000 Married 2 3.3% 1 3.3% Occupation Working 26 43.3% 9 30.0% 0.221 Non- working 34 56.7% 21 70.0% SD: Standard deviation Among the 60 acne patients, 38 patients (63.3%) experienced an intermittent disease course and the acne resolved spontaneously without intervention, while 22 patients (36.7%) had a progressive course. The mean of acne duration ± SD was (2.43 ± 0.91) and ranged from 1 to 5 years. The site of acne lesions was facial in 36 patients (60%), Truncal in 9 patients (15%) and mixed in face and trunk in 15 patients (25%). There was positive family history of acne in the first degree relatives in 38 patients (63.3%), this was shown in (Table 2 ). Table 2 Disease characteristics of the studied patients. n (60) % Course of the disease Progressive 22 36.7% Intermittent 38 63.3% Duration of the disease: (years) Mean ± SD 2.43 ± 0.91 Median (Range) 2.0 (1.0–5.0) Family history of acne Positive 38 63.3% Negative 22 36.7% Complications Yes 26 43.3% No 34 56.7% Current treatment Systemic antibiotic 40 66.7% Topical antibiotic 13 21.7% Topical tretinoin 7 11.7% Acne site Facial 36 60.0% Truncal 9 15.0% Mixed 15 25.0% The mean ± SD of GAGS among patients was (25.07 ± 9.03). In terms of disease severity, 20 cases (33.3%) were classified as mild, 20 cases (33.3%) as moderate and 20 patients (33.3%) as severe. The mean ± SD of BMI in acne patients was (26.23 ± 4.73) compared to (24.16 ± 4.67) in controls. Among the acne patients, 35% were overweight and 25% were obese compared to 26.7% and 13.3% of the controls respectively, without statistical significant difference, as shown in (Table 3 ). As regards waist circumference of the study participants, its mean ± SD in acne patients was (102.98 ± 12.37) versus (102.97 ± 15.35) in controls with no statistical significant difference (p = 0.996). Table 3 BMI of the study participants. BMI Patients (n = 60) Controls (n = 30) P-value n % n % BMI level: Normal 24 40.0% 18 60.0% Overweight 21 35.0% 8 26.7% 0.180 Obese 15 25.0% 4 13.3% BMI: (kg/m 2 ) Mean ± SD 26.23 ± 4.73 24.16 ± 4.67 0.052 Range 18.5–38.0 18.5–34.0 BMI: Body Mass Index; SD: standard deviation * Significant p-value < 0.05 There was a significant increase in FBG level in acne patients compared to controls (p = 0.047*). No significant difference in serum insulin levels was observed between the two groups. The acne patients group exhibited significantly higher levels of serum cholesterol, TG and LDL, while HDL levels were significantly lower compared to control group, as shown in (Table 4 ). Table 4 Comparison between acne patients and controls regarding laboratory investigations. Laboratory investigations Patients (n = 60) Controls (n = 30) P-value FBG: (mg/dl) Mean ± SD 86.42 ± 8.82 82.73 ± 6.70 0.047* Range 70.0-110.0 70.0–98.0 Insulin level: (uIU/mL) Mean ± SD 10.33 ± 6.31 9.12 ± 1.90 0.787 Median (Range) 9.4 (3.6–40.1) 9.1 (4.0–14.0) HOMA-IR : Mean ± SD 2.20 ± 1.49 1.87 ± 0.45 0.044* Median (Range) 1.9 (0.7–10.9) 1.81 (0.9-3.0) TG: (mg/dl) Mean ± SD 151.02 ± 39.80 96.12 ± 14.69 0.000* Range 74.7-209.6 75.0-127.2 HDL: (mg/dl) Mean ± SD 28.25 ± 9.86 39.16 ± 11.97 0.000* Range 7.4–42.6 9.7–57.6 Cholesterol: (mg/dl) Mean ± SD 180.29 ± 44.90 126.11 ± 17.47 0.000* Range 111.9–278.0 105.0-177.0 LDL: (mg/dl) Mean ± SD 165.95 ± 55.83 96.81 ± 34.93 0.000* Range 38.1-289.8 27.0-180.0 SD: standard deviation; * Significant p-value < 0.05 FBG: Fasting Blood Glucose; HOMA-IR: Homeostatic Model Assessment of Insulin Resistance; TG: Triglyceride; HDL: High density lipoprotein; LDL: Low density lipoprotein. The mean ± SD of serum apelin-12 level was significantly higher in acne patients (121.36 ± 51.63) compared to controls (73.48 ± 18.98) with a statistical significance difference (p = 0.000*). In acne patients group, serum apelin-12 showed a statistical significant positive correlation with BMI (r = 0.329, p = 0.010*), FBG levels (r = 0.554, p = 0.000*), serum insulin levels (r = 0.373, p = 0.003*), and HOMA-IR (r = 0.368, p = 0.004*). But there was no significant correlation between serum apelin-12 and waist circumference (r = 0.228, p = 0.080), this was shown in (Table 5 ). In control group, no statistical significant correlation was found between serum apelin-12 and BMI (r = 0.040, p = 0.835), also between serum apelin-12 and waist circumference (r = 0.073, p = 0.702). Table 5 Correlation between serum of apelin-12 and different variables in the studied acne patients. Apelin-12 (ng/ml) r-value P-value BMI (kg/m 2 ) 0.329 0.010* Waist circumference (cm) 0.228 0.080 FBG (mg/dl) 0.554 0.000* Insulin level (uIU/mL) 0.373 0.003* HOMA-IR 0.368 0.004* TG (mg/dl) 0.083 0.528 HDL (mg/dl) 0.218 0.094 Cholesterol (mg/dl) 0.197 0.130 LDL (mg/dl) 0.146 0.267 r = Correlation coefficient; * Significant p-value < 0.05 BMI: Body Mass Index; FBG: Fasting Blood Glucose; HOMA-IR: Homeostatic Model Assessment of Insulin Resistance; TG: Triglyceride; HDL: High density lipoprotein; LDL: Low density lipoprotein. A statistical significant positive correlation was found between serum apelin-12 and acne severity assessed by GAGS (r = 0.277, p = 0.032*), as shown in (Fig. 1 ). Also, serum apelin-12 level was significantly higher in patients with severe acne than those with mild and moderate acne (p = 0.000*). Additionally, a significant positive correlation was found between GAGS with BMI (r = 0.269, P = 0.037*) and GAGS with waist circumference (r = 0.281, P = 0.030*). On correlating GAGS with laboratory parameters, a statistical significant positive correlation was found between patients' GAGS and insulin levels (r = 0.794, p = 0.000*), HOMA-IR (r = 0.721, p = 0.000*), serum levels of cholesterol (r = 0.564, P = 0.000*), TG (r = 0.576, P = 0.000*) and LDL (r = 0.450, P = 0.000*) respectively. Validity of apelin-12 for discrimination between acne patients and healthy controls: ROC curve showed serum apelin-12 at cut off point > 97.22 (ng/ml) had 65% sensitivity and 96.67% specificity for prediction of AV with the area under the ROC curve (AUC) was = 0.813. At cut off value of 97.22, the positive predictive value (PPV) was 97.5%, the negative predictive value (NPV) was 58% and accuracy was 75.56%, as shown in (Table 6 & Fig. 2 ). Table 6 Validity of Apelin-12 for discrimination between acne patients and controls. Cut-off Sensitivity Specificity PPV NPV Accuracy AUC > 97.22 65.00 96.67 97.5 58.0 75.56 0.813 AUC: Area under curve, PPV: Positive predictive value, NPV: Negative predictive value. Discussion An inflammatory condition affecting the pilosebaceous unit is AV. Adipokines released from the sebaceous gland are thought to be unique variables affecting acne inflammation in the complex pathophysiology of acne. Previous studies have investigated the association between patients' serum levels of different adipokines and AV; however, the results have been inconsistent. 8 Various adipokines including apelin have been linked to the onset and the severity of certain dermatological diseases. Adipokines secreted from the sebaceous gland are considered novel factors affecting acne inflammation. Previous studies investigated the association between serum levels of various adipokines like leptin, adiponectin, and visfatin with AV. 9 Our study is a case control study conducted on a total of 60 patients with AV subdivided according to (GAGS) in to 3 equal subgroups (mild, moderate and severe patients) and age and sex matched 30 healthy individuals as controls. The study demonstrated no statistical significant differences between the acne patients and the controls in terms of age and sex, indicating that the groups were comparable and that personal characteristics did not interfere with the outcomes. Additionally, there were no significant differences in weight, BMI, and waist circumference between the two groups, aligning with the findings of a previous Egyptian study which also reported no significant differences in weight, height and BMI between acne cases and controls. 10 Our study found that the mean of FBG level was significantly higher in acne patients (86.42 ± 8.82) compared to controls (82.73 ± 6.70) (p = 0.047 * ). Severe and moderate acne cases exhibited significantly higher HOMA-IR scores than mild cases, indicating a positive correlation between IR and acne severity according to the GAGS. These findings are consistent with those of previous studies which reported significantly higher FBG levels in acne patients compared to healthy controls. 11 , 12 Additionally, our results were closely similar to that of a previous study which reported a significant positive relationship between IR and acne severity, severe acne patients showed higher IR than controls. 10 IR contributes to acne development and severity by increasing blood glucose levels, which in turn increases insulin secretion. Elevated insulin reduces the availability of Insulin-like growth factor-1 (IGF-1) binding protein, enhancing IGF-1 effects. IGF-1 promotes seborrhea and inflammation by downregulating Forkhead box protein-1 (FOXO), induces gonadal testosterone and adrenal dehydroepiandrosterone (DHEA) synthesis, and enhances the conversion of testosterone to dihydrotestosterone (DHT) by increasing 5-alpha reductase activity. It also inhibits hepatic synthesis of sex hormone-binding globulin, increasing the bioavailability of androgens. 13 In our study, we found that TG levels were significantly higher in acne cases (151.02 ± 39.80) compared to controls (96.12 ± 14.69), and both cholesterol and LDL levels were also higher in cases (180.29 ± 44.90 and 165.95 ± 55.83, respectively) than in controls (126.11 ± 17.47 and 96.81 ± 34.93, respectively). While HDL levels were lower in acne patients (28.25 ± 9.86) compared to controls (39.16 ± 11.97). Additionally, there was a significant positive correlation between TG, cholesterol and LDL levels and acne severity assessed by GAGS. These findings were in agreement with that of previous studies 14 , 15 which found higher TG, cholesterol and LDL levels in acne patients and correlated with acne severity. However, other studies 16 , 17 reported no significant differences in lipid profiles between acne patients and controls, except for lower HDL levels in severe acne cases. The novel result in our study was the significant higher serum levels of apelin-12 in acne patients compared to controls, with levels increasing in accordance with acne severity. This suggests that apelin-12 could be a marker for acne severity, and this in agreement with other study 18 which reported similar findings with apelin-13. Additionally, we found a positive correlation between serum apelin-12 and BMI, indicating higher levels in obese patients. Significant correlations were also observed between serum apelin-12 and FBG, fasting insulin, HOMA-IR and GAGS, suggesting a link between apelin levels, obesity and insulin resistance in acne patients. Apelin had a role in glucose metabolism and inflammation, may be upregulated by pro-inflammatory factors like TNF-α, which increases apelin expression in adipocytes and plasma, as demonstrated in previous studies. This dual role in metabolism and inflammation could explain the elevated apelin-12 levels in acne patients and its association with the disease severity. Our new finding was that serum apelin-12 levels were significantly higher in acne patients compared to controls and the levels of apelin-12 increased with acne severity assessed by GAGS. This suggests apelin-12 as a potential marker for acne severity. We also found that in acne patients the higher levels of apelin-12 correlated with BMI, FBG, fasting insulin, HOMA-IR and GAGS, indicating a link with obesity and insulin resistance. Apelin's roles in glucose metabolism and inflammation, possibly upregulated by factors like TNF-α, might explain its elevated levels and association with disease severity in acne patients. In conclusion , the study revealed a significant association between acne, serum apelin-12, and BMI, with elevated apelin-12 levels linked to the inflammatory state in acne patients and increased with acne severity assessed by GAGS. A strong association was found between acne severity and IR, highlighting the role of IR in acne pathogenesis. Detection of IR through HOMA-IR and serum fasting insulin levels, and management of IR can benefit the acne treatment. Additionally, serum apelin-12 level was positively correlated with insulin level and HOMA-IR, suggesting that apelin-12 may influence acne pathogenesis through its relationship with hyperinsulinemia and IGF-1, contributing to hyperkeratinization. The limitations of the study included the small sample size. Further studies are needed to fully understand the role of apelin-12 in acne pathogenesis and its potential as a therapeutic target. Declarations Conflicts of interest: The authors have no conflicts of interest to declare. Author Contribution Authors’ individual contribution:Eman M.K. Youssef and Doaa A.E. Abou-Taleb developed the study design and methodology of the study.Doaa A.E. Abou-Taleb and Amira A.H. Mohammed contributed in patients' history taking, clinical examination, treatment and data collection.Marwa A. Gaber was responsible for the laboratory assessment.All authors have been contributed significantly to the interpretation of the results and statistical analysis of the study.Doaa A.E. Abou-Taleb and Amira A.H. Mohammed contributed in constructing and writing up this manuscript. All authors contributed in revising the manuscript.All authors are aware of the submission and agree to it. References Tahir CM. Pathogenesis of acne vulgaris: simplified. Journal of Pakistan Association of Dermatologists. 2010;20(2):93-7. Dréno B. Treatment of adult female acne: a new challenge. Journal of the European Academy of Dermatology and Venereology. 2015;29:14-9. Gallitano S, Berson D. How acne bumps cause the blues: the influence of acne vulgaris on self-esteem. International journal of women's dermatology. 2018;4(1):12-7. Balta I, Ekiz O, Ozuguz P, Ustun I, Karaca S, Dogruk Kacar S, et al. Insulin resistance in patients with post‐adolescent acne. International journal of dermatology. 2015;54(6):662-6. Ozuguz P, Kacar S, Asik G, Ozuguz U, Karatas S. Evaluation of leptin, adiponectin, and ghrelin levels in patients with acne vulgaris. Human & experimental toxicology. 2017;36(1):3-7. Newson MJ, Pope GR, Roberts EM, Lolait SJ, O'Carroll A-M. Stress-dependent and gender-specific neuroregulatory roles of the apelin receptor in the hypothalamic–pituitary–adrenal axis response to acute stress. The Journal of endocrinology. 2012;216(1):99. Castan-Laurell I, Dray C, Attané C, Duparc T, Knauf C, Valet P. Apelin, diabetes, and obesity. Endocrine. 2011;40:1-9. Chang HC, Lin MH, Huang YC. Association between circulating adipokines and acne vulgaris: A systematic review and meta‐analysis. Australasian Journal of Dermatology. 2019;60(4). Demİrel ÖU, Demİrbaş B. Role Of Biomarkers In Acne Vulgaris. Theory and Research in Health Sciences. 2022. Abdelmawla MY, Esawy AM, Khater E, Khalifa NA. Insulin resistance in androgenetic alopecia and acne vulgaris. Egyptian Journal of Dermatology and Venerology. 2019;39(2):83-8. Hussain T, Tufail S, Farooq P. Association of Acne with Metabolic Syndrome and Insulin Resistance in Young Men. Journal of Medicine, Physiology and Biophysics. 2018;48:20-4. Sereen AEHM, Essam N, Aboeldahab M. Relation between acne vulgaris and metabolic syndrome in males. The Medical Journal of Cairo University. 2021;89(September):1409-15. Melnik BC, Schmitz G. Role of insulin, insulin‐like growth factor‐1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Experimental dermatology. 2009;18(10):833-41. Leelambika C, Sarkar P. Dyslipidemia in Patients with Acne Vulgaris: A Clinicobiochemical Study from a Tertiary Care Center. Indian Journal of Medical Biochemistry. 2019;23(3):321. Jiang H, Li CY, Zhou L, Lu B, Lin Y, Huang X, et al. Acne patients frequently associated with abnormal plasma lipid profile. The Journal of dermatology. 2015;42(3):296-9. El-Akawi Z, Abdel-Latif N, Abdul-Razzak K, Al-Aboosi M. The relationship between blood lipids profile and acne. Journal of health science. 2007;53(5):596-9. Arora MK, Seth S, Dayal S. The relationship of lipid profile and menstrual cycle with acne vulgaris. Clinical biochemistry. 2010;43(18):1415-20. Sorour N, Abdalhafeez N, Akl E, El-wahed A. Evaluation of Serum Apelin-13 in Acne Vulgaris Patients. Benha Journal of Applied Sciences. 2018;3(2):93-5. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6214265","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Study protocol","associatedPublications":[],"authors":[{"id":437832399,"identity":"e931f2db-d5fa-4d25-9a1a-d28c00250adc","order_by":0,"name":"Eman Youssef","email":"","orcid":"","institution":"Assiut University","correspondingAuthor":false,"prefix":"","firstName":"Eman","middleName":"","lastName":"Youssef","suffix":""},{"id":437832400,"identity":"f0294bd6-34fc-4a22-83c4-d9b57b52e4ce","order_by":1,"name":"Marwa Gaber","email":"","orcid":"","institution":"Assiut university","correspondingAuthor":false,"prefix":"","firstName":"Marwa","middleName":"","lastName":"Gaber","suffix":""},{"id":437832401,"identity":"8d5e0e25-5ae6-44d7-a231-bb3cfd3dda33","order_by":2,"name":"Amira Mohammed","email":"","orcid":"","institution":"Assiut University","correspondingAuthor":false,"prefix":"","firstName":"Amira","middleName":"","lastName":"Mohammed","suffix":""},{"id":437832402,"identity":"c8b07ab2-4573-4697-b140-8bd5e7b6df93","order_by":3,"name":"Doaa About-Taleb","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFElEQVRIiWNgGAWjYDCCAwiS8QBjgw1ElIcoLWxAkrEhjXQthwlr4Tve/PADQ80dOYP7zQ8OfNxxXt7gdgPjg7dtDHLyDti1SJ45ZizBcOyZscExNoODM8/cNtxw5wCz4dw2BmPDA9i1GNxIMJBgYDucuOEYg8Fh3rbbjBtuJLBJ87YxJG5swKUl/fMPhn8gLewfDv9tO2cP1ML+G6ilHreWHDMJxjaQFh6Dw4xtBxJBtjADtSTI4/C+5JkzZRaMfc+MJY/lFBzsPZOcPPNGYrPknHMShhtwhlj75hsM3+7I8R0+vvHBzx12tn03kg9+eFNmIy+Pw2EgwPwHlc8IUivBYHAAtxYcAJ8to2AUjIJRMKIAACwWbAo1ZeSjAAAAAElFTkSuQmCC","orcid":"","institution":"Assiut University","correspondingAuthor":true,"prefix":"","firstName":"Doaa","middleName":"","lastName":"About-Taleb","suffix":""}],"badges":[],"createdAt":"2025-03-12 18:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6214265/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6214265/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80049875,"identity":"2d054b38-37d0-4671-92f2-65ece6e4af6f","added_by":"auto","created_at":"2025-04-07 10:14:43","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":18693,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCorrelation between serum apelin-12 and GAGS in acne patients.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6214265/v1/254cecb0805fd91142a38180.jpg"},{"id":80049874,"identity":"e276e648-f961-4fca-9cc1-55c214cd059c","added_by":"auto","created_at":"2025-04-07 10:14:43","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30873,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003e1: ROC curve: the performance characteristics of serum Apelin-12 for detection of AV.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6214265/v1/eca8206d6f602b4830db5a06.jpg"},{"id":80051766,"identity":"73204903-eeab-42d7-a320-57f5052f8217","added_by":"auto","created_at":"2025-04-07 10:30:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1096030,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6214265/v1/f0a98813-ba30-4412-b876-d0051634e00e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Serum level of Apelin-12 in acne patients: Is it a marker of disease severity?","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe growth of non-inflammatory open and closed comedones as well as inflammatory papules, pustules, nodules, and cysts are the hallmarks of acne vulgaris (AV), a prevalent chronic inflammatory illness of the pilosebaceous unit.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAcne can progress to build scarring and become refractory purulent cysts, nodules, and subcutaneous fistulas that are resistant to treatment. Since sebaceous follicles are more prevalent on the face, neck, chest, and upper back, these areas are where it most frequently appears. It typically first manifests itself after puberty and can last until 40 or 50 years of age.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEven though AV is one of the most prevalent dermatological conditions, it has a significant detrimental impact on psychological functioning. Acne has been linked to increased rates of anxiety, despair, and inability to function in social situations.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNumerous studies have indicated that nutrition may have an impact on the pathophysiology of acne. Additionally, it has been demonstrated that in young individuals with AV, a low glycemic index diet improved both the severity of their acne and their insulin sensitivity at the same time. Consequently, the genesis and severity of acne may be influenced by insulin and the metabolism of carbohydrates.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAdipokines might be involved in the AV pathogenesis. In nonobese patients with moderate AV, leptin, adiponectin, ghrelin, and insulin resistance (IR) might not be involved in the underlying causes.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eApelin is a 36-amino acid peptide that is generated in particular hypothalamic neurons as a portion of a 77-amino acid prepropeptide precursor. It appears that apelin receptor (APJ), a single G protein-coupled receptor subtype, mediates its effects.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eApelin and APJ mRNA are recognized as important regulators of central and peripheral responses to numerous homeostatic perturbations. They are expressed in the brain, pituitary gland, heart, lung, adipose tissue, and gastrointestinal tract, among other organs.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe aim of the study is to detect the level of serum apelin-12 in acne and its correlation with body mass index (BMI), IR and acne severity assessed by Global Acne Grading Scale (GAGS).\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and population\u003c/h2\u003e \u003cp\u003eThis prospective case control study was performed at the Dermatology Department and Medical Biochemistry Department, Faculty of Medicine, Assiut University, Assiut, Egypt.\u003c/p\u003e \u003cp\u003e Our study was approved by the Research Ethics committee of Faculty of Medicine Assiut University (Approval number IRB 17100444) and it was carried out in accordance to the Helsinki Declaration guidelines. All participants gave their informed consent before enrollment in the study.\u003c/p\u003e \u003cp\u003eA total of ninety individuals were included in the study, sixty acne patients with mild, moderate and severe acne lesions were randomly recruited and enrolled in the study. Thirty healthy age and sex matched individuals were enrolled in the study as controls.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe exclusion criteria\u003c/b\u003e included: Pregnancy, lactation, patients with any systemic diseases as diabetes mellitus, renal failure and liver failure. Those having dermatological diseases other than acne vulgaris or having any systemic inflammatory diseases. Also, those receiving medications known to affect adipokines level (as oral retinoids and hypolipidaemic drugs) and hormonal treatment like oral contraceptive pills as it will positively influence the development of acne.\u003c/p\u003e \u003cp\u003eThe participants were divided into two groups:\u003c/p\u003e \u003cp\u003eStudy group: included sixty patients with active acne and control group: included thirty healthy individuals.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cp\u003eA detailed history was taken from each patient including name, age, sex, occupation, residence, marital status, disease onset, course, duration, previous treatment and its efficacy and family history of acne. General clinical examination was done to exclude any systemic diseases. Clinical evaluation included measuring waist circumference and calculating BMI.\u003c/p\u003e \u003cp\u003eBMI was calculated as weight in kilograms divided by height in meters. A BMI of 18.5 to 24.9 is considered normal (non-obese), 25 or higher (overweight), and 30 or higher (obese).\u003c/p\u003e \u003cp\u003eA full dermatological examination was performed to assess acne severity using the GAGS and to detect any additional skin conditions.\u003c/p\u003e\n\u003ch3\u003eLaboratory Analysis\u003c/h3\u003e\n\u003cp\u003eFive milliliters of peripheral venous blood was withdrawn from each patient and control after 10\u0026ndash;12 hours of fasting. The blood samples were allowed to clot completely (within 2 hours) at the room temperature. Centrifugation was done at 1000\u0026times;g. for 20 minutes to separate the serum. After centrifugation, serum was separated by a pipette, divided and kept in one eppendorf tube labeled with the patient number. Specimens were kept at 20\u0026deg;C to preserve until the time of the run, avoiding repeated freeze-thaw cycles. Sampling for FBG was determined at once.\u003c/p\u003e \u003cp\u003eLaboratory assessment included serum fasting blood glucose (FBG) level, serum fasting insulin level, IR, serum level of apelin-12 by enzyme-linked immunosorbent assay (ELISA) technique and serum complete lipid profile (Cholesterol, triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL).\u003c/p\u003e\n\u003ch3\u003eAssessment of serum FBG level:\u003c/h3\u003e\n\u003cp\u003eMeasurement of serum glucose was done using Glucose Assay Kit, applied by Abnova company (CAT: KA1648). Samples were run on device (DAS Plate reader, SN 2006, Italy).\u003c/p\u003e\n\u003ch3\u003eMeasurement of serum fasting insulin level:\u003c/h3\u003e\n\u003cp\u003eMeasurement of serum insulin was done using Human Insulin ELISA Kit, (CAT: 90095) Crystal Chem, USA. Samples were run on ELISA device (DAS Plate reader, SN 2006, Italy).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAssessment of IR:\u003c/h2\u003e \u003cp\u003eIR was calculated in all participants in the study via measuring of fasting serum insulin and FBG levels and calculated by HOMA-IR.\u003c/p\u003e \u003cp\u003eHOMA-IR= [Fasting glucose (mmol/L) x Fasting serum insulin (mIU/L)]\u0026thinsp;\u0026divide;\u0026thinsp;22.5. Normal value is below 2.5.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment of serum level of apelin-12:\u003c/h3\u003e\n\u003cp\u003eSerum apelin-12 levels were determined by ELISA (Human APLN (apelin-12) ELISA Kit Elabscience). Intra- and inter-assay CVs were 5%, and 14%, respectively.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData entry and analysis were done using SPSS version 22 (Statistical Package for Social Science). Data were presented as number, percentage, mean, standard deviation (SD), median and range. Chi-square test and Fisher Exact test were used to compare between qualitative variables. In case of parametric data, Independent samples t-test was used to compare quantitative variables between two groups and ANOVA/ Post-hoc (LSD) test for more than two groups. Pearson correlation was done to measure correlation between quantitative variables. While in case of non-parametric data, Mann-Whitney test was used to compare quantitative variables between two groups and Kruskal Wallis Test for more than two groups. Spearman correlation was done to measure correlation between quantitative variables. Medcalc was used to calculate sensitivity, specificity, positive and negative predictive values and receiver operating characteristic (ROC) curve. P-value was considered statistically significant when P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study involved 90 participants consisting of 60 acne patients and 30 age and sex matched healthy controls. The mean of age in acne patients\u0026thinsp;\u0026plusmn;\u0026thinsp;SD was (20.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75) and ranged from 15 to 27 years old, with a gender distribution of 44 females (73.3%) and 16 males (26.7%). Comparison between the two study groups revealed that there was no statistical significant difference regarding age, sex, residence, occupation and marital status (p-values\u0026thinsp;\u0026gt;\u0026thinsp;0.05), as shown in (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of the study participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePersonal data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge: (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e20.08\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e21.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.087\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e15.0\u0026ndash;27.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e17.0\u0026ndash;26.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.733\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.3%\u003c/p\u003e \u003cp\u003e36.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.3%\u003c/p\u003e \u003cp\u003e46.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.361\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon- working\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eSD: Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the 60 acne patients, 38 patients (63.3%) experienced an intermittent disease course and the acne resolved spontaneously without intervention, while 22 patients (36.7%) had a progressive course. The mean of acne duration\u0026thinsp;\u0026plusmn;\u0026thinsp;SD was (2.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91) and ranged from 1 to 5 years. The site of acne lesions was facial in 36 patients (60%), Truncal in 9 patients (15%) and mixed in face and trunk in 15 patients (25%). There was positive family history of acne in the first degree relatives in 38 patients (63.3%), this was shown in (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDisease characteristics of the studied patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCourse of the disease\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProgressive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntermittent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of the disease: (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.0 (1.0\u0026ndash;5.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily history of acne\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eComplications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCurrent treatment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystemic antibiotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTopical antibiotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTopical tretinoin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAcne site\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFacial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTruncal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMixed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of GAGS among patients was (25.07\u0026thinsp;\u0026plusmn;\u0026thinsp;9.03). In terms of disease severity, 20 cases (33.3%) were classified as mild, 20 cases (33.3%) as moderate and 20 patients (33.3%) as severe.\u003c/p\u003e \u003cp\u003eThe mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of BMI in acne patients was (26.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73) compared to (24.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67) in controls. Among the acne patients, 35% were overweight and 25% were obese compared to 26.7% and 13.3% of the controls respectively, without statistical significant difference, as shown in (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). As regards waist circumference of the study participants, its mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD in acne patients was (102.98\u0026thinsp;\u0026plusmn;\u0026thinsp;12.37) versus (102.97\u0026thinsp;\u0026plusmn;\u0026thinsp;15.35) in controls with no statistical significant difference (p\u0026thinsp;=\u0026thinsp;0.996).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBMI of the study participants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI level:\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI: (kg/m\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e26.23\u0026thinsp;\u0026plusmn;\u0026thinsp;4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e24.16\u0026thinsp;\u0026plusmn;\u0026thinsp;4.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e18.5\u0026ndash;38.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e18.5\u0026ndash;34.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eBMI: Body Mass Index; SD: standard deviation\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003e*\u003c/b\u003e Significant p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere was a significant increase in FBG level in acne patients compared to controls (p\u0026thinsp;=\u0026thinsp;0.047*). No significant difference in serum insulin levels was observed between the two groups. The acne patients group exhibited significantly higher levels of serum cholesterol, TG and LDL, while HDL levels were significantly lower compared to control group, as shown in (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison between acne patients and controls regarding laboratory investigations.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaboratory investigations\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;30)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBG: (mg/dl)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86.42\u0026thinsp;\u0026plusmn;\u0026thinsp;8.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.73\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.047*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70.0-110.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.0\u0026ndash;98.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsulin level: (uIU/mL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.33\u0026thinsp;\u0026plusmn;\u0026thinsp;6.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.787\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.4 (3.6\u0026ndash;40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1 (4.0\u0026ndash;14.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHOMA-IR\u003c/b\u003e:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.044*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedian (Range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.9 (0.7\u0026ndash;10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.81 (0.9-3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTG: (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151.02\u0026thinsp;\u0026plusmn;\u0026thinsp;39.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.12\u0026thinsp;\u0026plusmn;\u0026thinsp;14.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.7-209.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.0-127.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHDL: (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.25\u0026thinsp;\u0026plusmn;\u0026thinsp;9.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.16\u0026thinsp;\u0026plusmn;\u0026thinsp;11.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.4\u0026ndash;42.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.7\u0026ndash;57.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCholesterol: (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180.29\u0026thinsp;\u0026plusmn;\u0026thinsp;44.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126.11\u0026thinsp;\u0026plusmn;\u0026thinsp;17.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e111.9\u0026ndash;278.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105.0-177.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLDL: (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165.95\u0026thinsp;\u0026plusmn;\u0026thinsp;55.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.81\u0026thinsp;\u0026plusmn;\u0026thinsp;34.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRange\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.1-289.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.0-180.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSD: standard deviation; \u003cb\u003e*\u003c/b\u003e Significant p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eFBG: Fasting Blood Glucose; HOMA-IR: Homeostatic Model Assessment of Insulin Resistance; TG: Triglyceride; HDL: High density lipoprotein; LDL: Low density lipoprotein.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD of serum apelin-12 level was significantly higher in acne patients (121.36\u0026thinsp;\u0026plusmn;\u0026thinsp;51.63) compared to controls (73.48\u0026thinsp;\u0026plusmn;\u0026thinsp;18.98) with a statistical significance difference (p\u0026thinsp;=\u0026thinsp;0.000*).\u003c/p\u003e \u003cp\u003eIn acne patients group, serum apelin-12 showed a statistical significant positive correlation with BMI (r\u0026thinsp;=\u0026thinsp;0.329, p\u0026thinsp;=\u0026thinsp;0.010*), FBG levels (r\u0026thinsp;=\u0026thinsp;0.554, p\u0026thinsp;=\u0026thinsp;0.000*), serum insulin levels (r\u0026thinsp;=\u0026thinsp;0.373, p\u0026thinsp;=\u0026thinsp;0.003*), and HOMA-IR (r\u0026thinsp;=\u0026thinsp;0.368, p\u0026thinsp;=\u0026thinsp;0.004*). But there was no significant correlation between serum apelin-12 and waist circumference (r\u0026thinsp;=\u0026thinsp;0.228, p\u0026thinsp;=\u0026thinsp;0.080), this was shown in (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). In control group, no statistical significant correlation was found between serum apelin-12 and BMI (r\u0026thinsp;=\u0026thinsp;0.040, p\u0026thinsp;=\u0026thinsp;0.835), also between serum apelin-12 and waist circumference (r\u0026thinsp;=\u0026thinsp;0.073, p\u0026thinsp;=\u0026thinsp;0.702).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between serum of apelin-12 and different variables in the studied acne patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eApelin-12 (ng/ml)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.329\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.010*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWaist circumference (cm)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFBG (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.554\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInsulin level (uIU/mL)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.373\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHOMA-IR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.368\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTG (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.528\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHDL (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCholesterol (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLDL (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.267\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003er\u0026thinsp;=\u0026thinsp;Correlation coefficient; \u003cb\u003e*\u003c/b\u003e Significant p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eBMI: Body Mass Index; FBG: Fasting Blood Glucose; HOMA-IR: Homeostatic Model Assessment of Insulin Resistance; TG: Triglyceride; HDL: High density lipoprotein; LDL: Low density lipoprotein.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA statistical significant positive correlation was found between serum apelin-12 and acne severity assessed by GAGS (r\u0026thinsp;=\u0026thinsp;0.277, p\u0026thinsp;=\u0026thinsp;0.032*), as shown in (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Also, serum apelin-12 level was significantly higher in patients with severe acne than those with mild and moderate acne (p\u0026thinsp;=\u0026thinsp;0.000*).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAdditionally, a significant positive correlation was found between GAGS with BMI (r\u0026thinsp;=\u0026thinsp;0.269, P\u0026thinsp;=\u0026thinsp;0.037*) and GAGS with waist circumference (r\u0026thinsp;=\u0026thinsp;0.281, P\u0026thinsp;=\u0026thinsp;0.030*). On correlating GAGS with laboratory parameters, a statistical significant positive correlation was found between patients' GAGS and insulin levels (r\u0026thinsp;=\u0026thinsp;0.794, p\u0026thinsp;=\u0026thinsp;0.000*), HOMA-IR (r\u0026thinsp;=\u0026thinsp;0.721, p\u0026thinsp;=\u0026thinsp;0.000*), serum levels of cholesterol (r\u0026thinsp;=\u0026thinsp;0.564, P\u0026thinsp;=\u0026thinsp;0.000*), TG (r\u0026thinsp;=\u0026thinsp;0.576, P\u0026thinsp;=\u0026thinsp;0.000*) and LDL (r\u0026thinsp;=\u0026thinsp;0.450, P\u0026thinsp;=\u0026thinsp;0.000*) respectively.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eValidity of apelin-12 for discrimination between acne patients and healthy controls:\u003c/h2\u003e \u003cp\u003eROC curve showed serum apelin-12 at cut off point\u0026thinsp;\u0026gt;\u0026thinsp;97.22 (ng/ml) had 65% sensitivity and 96.67% specificity for prediction of AV with the area under the ROC curve (AUC) was =\u0026thinsp;0.813. At cut off value of 97.22, the positive predictive value (PPV) was 97.5%, the negative predictive value (NPV) was 58% and accuracy was 75.56%, as shown in (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e \u0026amp; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eValidity of Apelin-12 for discrimination between acne patients and controls.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCut-off\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSensitivity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSpecificity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePPV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNPV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAccuracy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAUC\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;97.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.813\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eAUC: Area under curve, PPV: Positive predictive value, NPV: Negative predictive value.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAn inflammatory condition affecting the pilosebaceous unit is AV. Adipokines released from the sebaceous gland are thought to be unique variables affecting acne inflammation in the complex pathophysiology of acne. Previous studies have investigated the association between patients' serum levels of different adipokines and AV; however, the results have been inconsistent.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eVarious adipokines including apelin have been linked to the onset and the severity of certain dermatological diseases. Adipokines secreted from the sebaceous gland are considered novel factors affecting acne inflammation. Previous studies investigated the association between serum levels of various adipokines like leptin, adiponectin, and visfatin with AV.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e Our study is a case control study conducted on a total of 60 patients with AV subdivided according to (GAGS) in to 3 equal subgroups (mild, moderate and severe patients) and age and sex matched 30 healthy individuals as controls.\u003c/p\u003e \u003cp\u003eThe study demonstrated no statistical significant differences between the acne patients and the controls in terms of age and sex, indicating that the groups were comparable and that personal characteristics did not interfere with the outcomes. Additionally, there were no significant differences in weight, BMI, and waist circumference between the two groups, aligning with the findings of a previous Egyptian study which also reported no significant differences in weight, height and BMI between acne cases and controls.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur study found that the mean of FBG level was significantly higher in acne patients (86.42\u0026thinsp;\u0026plusmn;\u0026thinsp;8.82) compared to controls (82.73\u0026thinsp;\u0026plusmn;\u0026thinsp;6.70) (p\u0026thinsp;=\u0026thinsp;0.047\u003cb\u003e*\u003c/b\u003e). Severe and moderate acne cases exhibited significantly higher HOMA-IR scores than mild cases, indicating a positive correlation between IR and acne severity according to the GAGS. These findings are consistent with those of previous studies which reported significantly higher FBG levels in acne patients compared to healthy controls.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAdditionally, our results were closely similar to that of a previous study which reported a significant positive relationship between IR and acne severity, severe acne patients showed higher IR than controls.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e IR contributes to acne development and severity by increasing blood glucose levels, which in turn increases insulin secretion. Elevated insulin reduces the availability of Insulin-like growth factor-1 (IGF-1) binding protein, enhancing IGF-1 effects. IGF-1 promotes seborrhea and inflammation by downregulating Forkhead box protein-1 (FOXO), induces gonadal testosterone and adrenal dehydroepiandrosterone (DHEA) synthesis, and enhances the conversion of testosterone to dihydrotestosterone (DHT) by increasing 5-alpha reductase activity. It also inhibits hepatic synthesis of sex hormone-binding globulin, increasing the bioavailability of androgens.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn our study, we found that TG levels were significantly higher in acne cases (151.02\u0026thinsp;\u0026plusmn;\u0026thinsp;39.80) compared to controls (96.12\u0026thinsp;\u0026plusmn;\u0026thinsp;14.69), and both cholesterol and LDL levels were also higher in cases (180.29\u0026thinsp;\u0026plusmn;\u0026thinsp;44.90 and 165.95\u0026thinsp;\u0026plusmn;\u0026thinsp;55.83, respectively) than in controls (126.11\u0026thinsp;\u0026plusmn;\u0026thinsp;17.47 and 96.81\u0026thinsp;\u0026plusmn;\u0026thinsp;34.93, respectively). While HDL levels were lower in acne patients (28.25\u0026thinsp;\u0026plusmn;\u0026thinsp;9.86) compared to controls (39.16\u0026thinsp;\u0026plusmn;\u0026thinsp;11.97). Additionally, there was a significant positive correlation between TG, cholesterol and LDL levels and acne severity assessed by GAGS. These findings were in agreement with that of previous studies\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e which found higher TG, cholesterol and LDL levels in acne patients and correlated with acne severity. However, other studies\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e reported no significant differences in lipid profiles between acne patients and controls, except for lower HDL levels in severe acne cases.\u003c/p\u003e \u003cp\u003eThe novel result in our study was the significant higher serum levels of apelin-12 in acne patients compared to controls, with levels increasing in accordance with acne severity. This suggests that apelin-12 could be a marker for acne severity, and this in agreement with other study\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e which reported similar findings with apelin-13.\u003c/p\u003e \u003cp\u003eAdditionally, we found a positive correlation between serum apelin-12 and BMI, indicating higher levels in obese patients. Significant correlations were also observed between serum apelin-12 and FBG, fasting insulin, HOMA-IR and GAGS, suggesting a link between apelin levels, obesity and insulin resistance in acne patients. Apelin had a role in glucose metabolism and inflammation, may be upregulated by pro-inflammatory factors like TNF-α, which increases apelin expression in adipocytes and plasma, as demonstrated in previous studies. This dual role in metabolism and inflammation could explain the elevated apelin-12 levels in acne patients and its association with the disease severity.\u003c/p\u003e \u003cp\u003eOur new finding was that serum apelin-12 levels were significantly higher in acne patients compared to controls and the levels of apelin-12 increased with acne severity assessed by GAGS. This suggests apelin-12 as a potential marker for acne severity. We also found that in acne patients the higher levels of apelin-12 correlated with BMI, FBG, fasting insulin, HOMA-IR and GAGS, indicating a link with obesity and insulin resistance. Apelin's roles in glucose metabolism and inflammation, possibly upregulated by factors like TNF-α, might explain its elevated levels and association with disease severity in acne patients.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIn conclusion\u003c/b\u003e, the study revealed a significant association between acne, serum apelin-12, and BMI, with elevated apelin-12 levels linked to the inflammatory state in acne patients and increased with acne severity assessed by GAGS. A strong association was found between acne severity and IR, highlighting the role of IR in acne pathogenesis. Detection of IR through HOMA-IR and serum fasting insulin levels, and management of IR can benefit the acne treatment.\u003c/p\u003e \u003cp\u003eAdditionally, serum apelin-12 level was positively correlated with insulin level and HOMA-IR, suggesting that apelin-12 may influence acne pathogenesis through its relationship with hyperinsulinemia and IGF-1, contributing to hyperkeratinization.\u003c/p\u003e \u003cp\u003eThe limitations of the study included the small sample size. Further studies are needed to fully understand the role of apelin-12 in acne pathogenesis and its potential as a therapeutic target.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u0026nbsp;\u003c/strong\u003eThe authors have no conflicts of interest to declare.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthors\u0026rsquo; individual contribution:Eman M.K. Youssef and Doaa A.E. Abou-Taleb developed the study design and methodology of the study.Doaa A.E. Abou-Taleb and Amira A.H. Mohammed contributed in patients' history taking, clinical examination, treatment and data collection.Marwa A. Gaber was responsible for the laboratory assessment.All authors have been contributed significantly to the interpretation of the results and statistical analysis of the study.Doaa A.E. Abou-Taleb and Amira A.H. Mohammed contributed in constructing and writing up this manuscript. All authors contributed in revising the manuscript.All authors are aware of the submission and agree to it.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTahir CM. Pathogenesis of acne vulgaris: simplified. Journal of Pakistan Association of Dermatologists. 2010;20(2):93-7.\u003c/li\u003e\n\u003cli\u003eDr\u0026eacute;no B. Treatment of adult female acne: a new challenge. Journal of the European Academy of Dermatology and Venereology. 2015;29:14-9.\u003c/li\u003e\n\u003cli\u003eGallitano S, Berson D. How acne bumps cause the blues: the influence of acne vulgaris on self-esteem. International journal of women\u0026apos;s dermatology. 2018;4(1):12-7.\u003c/li\u003e\n\u003cli\u003eBalta I, Ekiz O, Ozuguz P, Ustun I, Karaca S, Dogruk Kacar S, et al. Insulin resistance in patients with post‐adolescent acne. International journal of dermatology. 2015;54(6):662-6.\u003c/li\u003e\n\u003cli\u003eOzuguz P, Kacar S, Asik G, Ozuguz U, Karatas S. Evaluation of leptin, adiponectin, and ghrelin levels in patients with acne vulgaris. Human \u0026amp; experimental toxicology. 2017;36(1):3-7.\u003c/li\u003e\n\u003cli\u003eNewson MJ, Pope GR, Roberts EM, Lolait SJ, O\u0026apos;Carroll A-M. Stress-dependent and gender-specific neuroregulatory roles of the apelin receptor in the hypothalamic\u0026ndash;pituitary\u0026ndash;adrenal axis response to acute stress. The Journal of endocrinology. 2012;216(1):99.\u003c/li\u003e\n\u003cli\u003eCastan-Laurell I, Dray C, Attan\u0026eacute; C, Duparc T, Knauf C, Valet P. Apelin, diabetes, and obesity. Endocrine. 2011;40:1-9.\u003c/li\u003e\n\u003cli\u003eChang HC, Lin MH, Huang YC. Association between circulating adipokines and acne vulgaris: A systematic review and meta‐analysis. Australasian Journal of Dermatology. 2019;60(4).\u003c/li\u003e\n\u003cli\u003eDemİrel \u0026Ouml;U, Demİrbaş B. Role Of Biomarkers In Acne Vulgaris. Theory and Research in Health Sciences. 2022.\u003c/li\u003e\n\u003cli\u003eAbdelmawla MY, Esawy AM, Khater E, Khalifa NA. Insulin resistance in androgenetic alopecia and acne vulgaris. Egyptian Journal of Dermatology and Venerology. 2019;39(2):83-8.\u003c/li\u003e\n\u003cli\u003eHussain T, Tufail S, Farooq P. Association of Acne with Metabolic Syndrome and Insulin Resistance in Young Men. Journal of Medicine, Physiology and Biophysics. 2018;48:20-4.\u003c/li\u003e\n\u003cli\u003eSereen AEHM, Essam N, Aboeldahab M. Relation between acne vulgaris and metabolic syndrome in males. The Medical Journal of Cairo University. 2021;89(September):1409-15.\u003c/li\u003e\n\u003cli\u003eMelnik BC, Schmitz G. Role of insulin, insulin‐like growth factor‐1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris. Experimental dermatology. 2009;18(10):833-41.\u003c/li\u003e\n\u003cli\u003eLeelambika C, Sarkar P. Dyslipidemia in Patients with Acne Vulgaris: A Clinicobiochemical Study from a Tertiary Care Center. Indian Journal of Medical Biochemistry. 2019;23(3):321.\u003c/li\u003e\n\u003cli\u003eJiang H, Li CY, Zhou L, Lu B, Lin Y, Huang X, et al. Acne patients frequently associated with abnormal plasma lipid profile. The Journal of dermatology. 2015;42(3):296-9.\u003c/li\u003e\n\u003cli\u003eEl-Akawi Z, Abdel-Latif N, Abdul-Razzak K, Al-Aboosi M. The relationship between blood lipids profile and acne. Journal of health science. 2007;53(5):596-9.\u003c/li\u003e\n\u003cli\u003eArora MK, Seth S, Dayal S. The relationship of lipid profile and menstrual cycle with acne vulgaris. Clinical biochemistry. 2010;43(18):1415-20.\u003c/li\u003e\n\u003cli\u003eSorour N, Abdalhafeez N, Akl E, El-wahed A. Evaluation of Serum Apelin-13 in Acne Vulgaris Patients. Benha Journal of Applied Sciences. 2018;3(2):93-5.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Acne vulgaris, apelin-12, insulin resistance, BMI, GAGS, lipid profile, inflammation","lastPublishedDoi":"10.21203/rs.3.rs-6214265/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6214265/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAcne vulgaris (AV) is a common inflammatory skin condition often associated with metabolic and hormonal factors. Our aim to assess the role of serum apelin-12 in acne and its correlation with body mass index (BMI), insulin resistance (IR) and acne severity.\u003c/p\u003e\u003ch2\u003ePatients and Methods:\u003c/h2\u003e \u003cp\u003eNinety individuals were included in this case control study, comprising 60 acne patients and 30 age and sex matched healthy controls. Detailed history was taken. Clinical evaluations included BMI, waist circumference, and assessment of acne severity using the Global Acne Grading Scale (GAGS). Laboratory tests measured serum fasting blood glucose (FBG), fasting insulin, serum apelin-12 and complete lipid profile. Insulin resistance (IR) was assessed using HOMA-IR.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAcne patients had significantly higher serum apelin-12 levels (121.36\u0026thinsp;\u0026plusmn;\u0026thinsp;51.63) compared to controls (73.48\u0026thinsp;\u0026plusmn;\u0026thinsp;18.98) (p\u0026thinsp;=\u0026thinsp;0.000*). Apelin-12 level increased with acne severity assessed by GAGS and was positively correlated with BMI, FBG, fasting insulin level and HOMA-IR. Triglycerides (TG), cholesterol and low-density lipoprotein (LDL) levels were also higher in acne patients compared to controls, while high-density lipoprotein (HDL) levels were lower. A significant association was found between acne severity and IR, suggesting that IR plays a crucial role in the pathogenesis of AV.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study suggests serum apelin-12 as a potential marker for acne severity, with its level correlated with BMI, IR and the inflammatory state of acne. The significant correlation between acne severity and IR highlights the importance of managing IR in treatment of acne.\u003c/p\u003e","manuscriptTitle":"Serum level of Apelin-12 in acne patients: Is it a marker of disease severity?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-07 10:14:39","doi":"10.21203/rs.3.rs-6214265/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-25T22:23:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-16T18:15:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"264899476231236891902254681506249035557","date":"2025-04-09T17:10:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T13:00:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T00:21:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"226022309800311413699780401551320316235","date":"2025-04-07T21:49:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-07T09:29:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37555923642555094491594983522281055766","date":"2025-04-04T14:29:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-03T08:16:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-03T06:37:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"224888348876812182169823257313650935793","date":"2025-04-03T06:23:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3759934493752652230616052170440442906","date":"2025-04-02T12:40:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113303953926608043670820264090544823539","date":"2025-03-27T10:49:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132303101691421146237187218426079939504","date":"2025-03-27T09:17:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235833461207690090020372636360324593676","date":"2025-03-25T17:24:12+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-25T08:57:30+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-14T11:51:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-14T11:47:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Dermatological Research","date":"2025-03-12T18:03:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-dermatological-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Archives of Dermatological Research](https://www.springer.com/journal/403)","snPcode":"403","submissionUrl":"https://submission.nature.com/new-submission/403/3","title":"Archives of Dermatological Research","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b723fa79-1d2a-4079-9ee9-9ab065471f65","owner":[],"postedDate":"April 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-09-03T04:53:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-07 10:14:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6214265","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6214265","identity":"rs-6214265","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}