INTRODUCTION:

Zinc is a trace element which plays a role in delayed type hypersensitivity reactions, regulation of inflammation, normal keratogenesis, cell membrane stabilization and many enzymatic reactions [1]. Zinc may be held in metallothianein reserves within microorganisms or in the intestines or liver of animals. Metallothianein in intestinal cells is capable of adjusting absorption of Zn by 15-40%. Zinc is the second most abundant transition metal in organisms after iron, and it is the only metal which appears in all enzyme classes.

The acne like lesions in zinc deficiency have lead investigators from different countries to assess the relationship between the serum zinc levels and acne [2-7]. Zinc was combined to acne treatment and it is still being used with varying rates of success [8- 11]. However, there is only one report available on serum zinc levels in acne patients from India [12].

Acne vulgaris is one of the common skin diseases in young individuals all over India and it has a lot of social and psychological impact on the individual’s behavior and performance in his/her daily life. Therefore, we investigated serum zinc levels in young patients with acne vulgaris who were doing their high school or college studies.

MATERIAL AND METHOD:

Young female patients of the age group between 13 and 19 years, attending the out-patient department of Dermatology of a tertiary teaching general hospital over a period of six months, with the problem of acne were included in this study. Female attenders (friends) of the patients of the same age, without acne comprised of the control group. The patients were explained about the purpose of the research project and informed consent was taken. This project was approved by ethics committee of the medical college/hospital. Every student was tested for haemoglobin level by using finger prick test and was excluded from the study if the haemoglobin was less than 10 gms/dl, because zinc deficiency can manifest as anemia which may further lower serum zinc values [13]. All the patients were advised overnight fasting. The blood samples of patients and controls were collected on the scheduled date and analysed for zinc levels at National Institute of Nutrition, Hyderabad by Atomic absorption spectrometry (SVL spectronics, Andhra Pradesh, India). The mean values of serum zinc in patients group and control group were tested for statistical significance by using independent sample t test. The P value <0.01 was considered as significant.

RESULTS:

The study comprised of 50 female acne patients and 25 controls of same age. The table 1 portraits the mean serum Zn levels in patients (24.4 ± 2.4 mg/dl) was significantly lower than in controls (99.4 ± 4.5 mg/dl), (P <0.001).

Table 1. Serum zinc profile in patients and controls.

Parameter	Patients group	Control group
Total subjects studied	50	25
Age group	13-19 years	13-19 years
Mean serum zinc level	24.4 ± 2.4 mg/dl	99.4 ± 4.5 mg/dl
Range of serum zinc level	16.5µg/dl - 30.1µg/dl	120µg/dl - 136 µg/dl

DISCUSSION:

Acne vulgaris is a common dermatological disease, common in adolescence with psychological impact, adverse effects being mild cosmetic problems to advanced stage of scarring. It is characterized by skin eruption on the face, chest, neck and back. It happens when the oil gland in the skin become plugged for many reasons. When oil backs up, it becomes infected by bacteria P.acne that is normally present on the skin and acne vulgaris develops. Zinc is a trace element that is necessary for epithelial differentiation and normal pubertal growth. It is present in high amounts within the epidermis of skin [14]. Zinc deficiency in acne patients has been associated with nutritional deficiency, dieting process, decreased absorption and increased excretion in sweat or feces. The inflammatory reaction is another factor decreasing serum zinc levels in these patients [8].

It has been suggested that nutritional factors such as vitamins and minerals are involved in the pathogenesis of acne [14,15]. The effect of zinc on inflammatory cells and granulocytes is the most important mechanism related to acne [11]. Zinc stabilizes macromolecules and lysozymes, increases the speed of neutrophil chemotaxis, and plays a regulatory role in the bactericidal activity and phagocytosis [16]. Fitzherbert [17] reported that zinc may have some influence on vitamin A transport and utilization through some enzymes and prevent keratinization and follicular obstruction. Damage to zinc dependant enzyme system in androgen synthesis is thought to be another mechanism explaining zinc deficiency and development of acne vulgaris. Conversion of testosterone to dihydrotestosterone is brought by reductase enzyme, and zinc in sufficient amounts inhibits this enzyme. So if zinc is deficient it promotes the conversion of testosterone to dihydrotestosterone which promotes the production of sebum and dilatation of sebaceous glands so sebum accumulates resulting in acne [18].

Amer et al [2] have compared the serum zinc levels in 50 patients with acne vulgaris and 38 controls, and found statistically significantly lower zinc levels in grade III and IV acne patients compared to controls. All these studies provide a rationale for beneficial effect of oral zinc therapy in acne patients. Pohit et al [3] suggested that people with acne have lower than normal levels of zinc in their bodies.

Kaymak et al [4] from Turkey have studied serum zinc levels in 47 patients with acne vulgaris and 40 volunteers without acne and reported that lower serum zinc level than normal was found in 54.1% of patients and in 10% of volunteers which was statistically significant (p<0.05). They believe that the zinc deficiency in their patients may be related to inadequate and unbalanced nutrition. Nasiri et al [5] reported lower serum zinc levels in 30 Iranian patients than that of 35 healthy controls; however, this difference was not significant (P=0.32).

Saleh et al [6] estimated serum zinc, copper and magnesium levels in 45 Iraqi patients with acne vulgaris and 45 healthy controls, and reported that serum levels of zinc was significantly decreased in severe acne group compared with controls, mild and moderate groups of acne patients (P<0.05). Sherman et [7] estimated serum zinc levels in 73 Iraqi individuals with acne vulgaris and in 42 healthy individuals as a control group. The study revealed that there was significantly decreased level of zinc in the patients by comparison with the control group.

Michaelson et al [8] studied zinc levels in the serum, epidermis and dermis of 73 patients with inflammatory acne and found that epidermal and dermal zinc levels were lower than in controls, while serum zinc levels were similar; there was no association between serum zinc levels and epidermal and dermal zinc levels. In contrast to this study, the serum zinc levels were significantly lower than in controls in our study.

Arora et al [12] studied 75 Indian patients of different cutaneous disorders (psoriasis, acne vulgaris, leprosy, vitiligo and aphthus ulcer, 15 each) and 24 healthy controls. Serum zinc level was found to be significantly lower in acne vulgaris (71.5 ± 21.5 µg/dl) as compared to healthy controls (105.2 ± 23.5 µg/dl).

In the present study, mean serum zinc levels in patients with acne was 24.4 ± 2.4 mg/dl in comparison to controls which is 99.4 ± 4.58 mg/dl mean zinc level in patients is significantly lowered compared to controls (P value <0.001), which is further supporting the afore cited studies. After the statistical analysis both the groups i.e. patients and controls were found to be non homogenous and nonparametric as shown by parametric t test, so nonparametric statistical test i.e. ‘U’ test is performed which also gives same result (P <0.001). All samples are fasting specimens, which rules out the possibility of any interference with zinc absorption as the cause of hypozincaemia.

Zinc tablets are used with various success rates in the treatment of patients with inflammatory acne [8-11]. Oral zinc sulphate/citrate effervescent tablets or zinc sulphate tablets (400-600 mg daily) has been recommended for acne treatment [8, 19]. Topical zinc therapy also was evaluated for acne by Cochran et al [20] and Schachner et al [21].

CONCLUSION:

From the present study we postulate that serum zinc is significantly low in acne vulgaris patients and hence, adjunctive zinc therapy (in the form of oral medication as well as in the daily diet) can help in the successful management of patients with acne as zinc deficiency is one of the main major causes.

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Received on 31.03.2013 Modified on 12.04.2013

Asian J. Research Chem. 6(5): May 2013; Page 464-466