Introduction
Acne vulgaris (AV) is a chronic multifactorial inflammatory disease of
the pilosebaceous units of the skin that affects 80% of adolescents and
young adults 1. The four main factors implicated in
the pathogenesis of AV are the abnormal follicular desquamation,
increased sebum production, Propionibacterium acnes proliferation and
inflammation 2.
Isotretinoin (13-cis-retinoic acid) is a systematic retinoid and Vitamin
A (retinol) metabolite, which constitutes the only available medication
with a potential for a long-term cure of acne, as it acts on all the
pathogenic mechanisms of acne 3,4. Isotretinoin is the
first line treatment for severe nodulocystic and papulopustular acne,
acne localized both on face and trunk, acne with tendency to scarring
and acne with psychological effects, but it is also indicated in cases
with mild to moderate acne, unresponsive to other topical or systematic
therapy 3.
Although isotretinoin is an effective and relatively well-tolerated
medication, many side effects are related with its intake. In the serum
of patients treated with isotretinoin, an increase in the levels of
total cholesterol and triglycerides and a decrease in the levels of high
density lipoprotein (HDL) are commonly noticed, a phenotype also
observed in patients with insulin resistance 5.
Recent studies have shown that adipose tissue, except its main function
as an energy-storing organ, has immunological and endocrinological
functions. The hormones secreted by fat tissue are called
adipocytokines, with the main representative of them, adiponectin.
Adiponectin is not only an anti-inflammatory agent, inhibiting
inflammation in a wide range of cell types, but also hinders liver
glucose production, increases insulin sensitivity and contributes in the
maintenance of whole-body’s energy homeostasis 6.
Previous studies with subject the influence of isotretinoin on insulin
resistance and serum adiponectin levels in patients with AV have given
controversial conclusions 7,8. The objective of this
systematic review and meta-analysis is therefore to evaluate the effect
of isotretinoin on glucose metabolism, focusing mainly on changes in
insulin resistance and levels of adiponectin.