Pınar Özuğuz, Seval Kaçar, Serap Polat, Sena Ulu, Şemsettin Karaca

İSOTRETİNOİN TEDAVİSİNİN NÖTROFİL/LENFOSİT ORANI VE DİĞER HEMOGRAM PARAMETRELERİNE ETKİSİNİN DEĞERLENDİRİLMESİ

Amaç: Akne vulgariste sıklıkla kullanılanisotretinoin tedavisi sırasında pek çok farklı yanetki gelişebildiği bildirilmektedir. Son zamanlardayapılan çalışmalarda isotretinoin kullanan hastalarınkontrollerinde biyokimya ve hemogram gibilaboratuvar tetkiklerinin gerekliliği konusundatartışmalı görüşler bulunmaktadır. Bu çalışmadaisotretinoin tedavisi alan hastalarda sistemikinflamatuvar durumu göstermede kullanılannötrofil/lenfosit oranı ve diğer hemogramparametrelerindeki değişimi araştırmayı amaçladık.Gereç ve yöntemler: İsotretinoin tedavisi kullanan,18-25 yaş aralığında, orta ve şiddetli akne vulgarisiolan 67 hasta çalışmaya dahil edildi. Retrospektifolarak hastaların tedavi öncesi ve tedavinin 3.ayından sonraki hemogram parametreleri SPSS20.0 programına kaydedildi.Bulgular: Yaş ortalaması 21.12 ± 3.54 olanhastaların 37’si bayan, 30’u erkek idi. Hemogramparametrelerinden beyaz küre, nötrofil sayısı,lenfosit sayısı ve nötrofil / lenfosit oranında 2 değerarasında istatistiksel olarak farklılık saptanmadı.Diğer parametrelerden monosit düzeylerindeistatistiksel olarak anlamlı bir artış saptanırken,bazofil, eozinofil, platelet ve hemotokritdüzeylerinde fark görülmedi. Kırmızı hücreler,hemoglobin, kırmızı hücrelerin ortalama volumü veplateletokrit düzeyleri arasında istatistiksel olarakanlamlı azalma gözlendi.Sonuç: İsotretinoin tedavisi hemogramparametrelerinde değişikliklere yol açabilir. İlaçkullanım süresince özellikle hemoglobindüşüklüğüne, monosit artışına neden olabilir.Anemisiolan hastaları isotretinoin tedavisialtındayken yakın takip etmek gerekebilir.Buparametrelerin değerlendirildiği, çok sayıdahastanın yer aldığı çok merkezli çalışmalara ihtiyaçduyulmaktadır.

Anahtar Kelimeler:

Anahtar hemogram parametreleri, hemoglobin, monosit, nötrofil/lenfosit oranı kelimeler: Eozinofil, isotretinoin

Evaluation of the efficacy of isotretinoin treatment on neutrophil/lymphocyte ratio and the other hemogram parameters

Aim: There are reports of various side effects of isotretinoin. Recent studies have controversial results about the necessity of laboratory investigation including hemogram and blood chemistry of patients during the follow up periodon isotretinoin.We aimed to investigate the effects of isotretinoin on Neutrophil/lymhocyte ratio (NLR) a systemic inflammation marker and the other hemogram parameters. Material and methods: Sixty seven patients with moderate to severe acne vulgaris aged between 18 to 25, who were prescribed 0.5mg/kg isotretinoin, were included to the study. Patients’ hemogram parameters before treatment and at the third month of treatment were recorded on SPSS 20.0 programme retrospectively. The difference between two values <0.05 was considered as statistically significant. Results: There were 37 female and 30 male patients, with a mean age of 21.12±3.54 years. There were no differences between the two groups by means of white blood count, neutrophil, lymphocyte counts and NLR. Among the other parameters, there was a statistically significant increase in monocyte count whereas basophil, eosinophil, platelet counts and hematocrit values revealed no differences. Red blood cells, hemoglobin, mean corpuscular volume and plateletocrit values revealed a statistically significant decrease (p<0.01). Conclusion: Isotretinoin, which is used as a miracle drug and favorable treatment of acne, may cause changes in hemogram parameters. It may lead to decreased hemoglobin values and increase of monocyte count during treatment. Patients with prominent iron deficiency may require close monitorization. Besides the unchanged NLR values may support no inflammatory reactions occur during muticentered studies, evaluating these parameters with larger sample sizes are required. isotretinoin treatment. Obviously

Keywords:

Isotretinoin, hemogram parameters, hemoglobulin, neutrophil/lymphocyte ratio monocyte, eosinophil,

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Degitz K, Placzek M, Borelli C, Plewig G. Pathophysiology of acne. J Dtsch Dermatol
Ges 2007;5:316-23.
Ertam I, Alper S, Unal I. Is it necessary to have routine blood tests inpatients treated
with isotretinoin? J Dermatolog Treat 2006;17:214–6.
Michaelsson G, Vahlquist A, Mobacken H, Hersle K, Landegren J, Ronnerfalt L, et al.
Changes in laboratory variables induced by isotretinoin treatment of acne. Acta Derm
Venereol. 1986;66:144–8.
Moeller KE, Touma SC. Prolonged thrombocytopenia associated with isotretinoin.
Ann Pharmacother. 2003;37:1622–4.
Karadag AS, Ertugrul DT, Takci Z. Isotretinoin modestly increases platelet count in
acne patients.J Dermatolog Treat. 2013;24(2):139-40.
Sen BB, Rifaioglu EN, Ekiz O, Inan MU, Sen T, Sen N. Neutrophil to lymphocyte
ratio as a measure of systemic inflammation in psoriasis. Cutan Ocul Toxicol. 2013
Oct 22. [Epub ahead of print]
Jones H, Blanc D, Cunliffe WJ. 13-cis retinoic acid and acne. Lancet 1980; 2: 1048–9.
Farrell LN, Strauss JS, Stranieri AM. The treatment of severe cystic acne with 13-cisretinoic
acid. Evaluation of sebum production and the clinical response in a multipledose
trial. J Am Acad Dermatol. 1980; 3: 602–11.
Hesdorffer CS, Weltman MD, Raftopoulos H, Mendelow B, Bezwoda WR.
Thrombocytopenia caused by isotretinoin.S Afr Med J. 1986;70(11):705-6.
Coto-Segura P, Galache C, Santos-Juanes J, Mallo-García S, Curto-Iglesias JR.
Transient thrombocytopenia probably induced by isotretinoin. Actas Dermosifiliogr.
;99(9):743-4.
Michaëlsson G, Vahlquist A, Mobacken H, Hersle K, Landegren J, Rönnerfält L,
Nordin K, Franzén K, Pettersson U. Changes in laboratory variables induced by
isotretinoin treatment of acne. Acta Derm Venereol. 1986;66(2):144-8.
Friedman SJ. Leukopenia and neutropeniaassociated with isotretinoin therapy. Arch
Dermatol. 1987;123(3):293-5.
Ozdemir MA, Kose M, Karakukcu M, Ferahbas A, Patiroglu T, Koklu E. Isotretinoininducedagranulocytosis.
Pediatr Dermatol. 2007 Jul-Aug;24(4):425-6.
Zane LT, Leyden WA, Marqueling AL, Manos MM. A population-based analysis of
laboratory abnormalities during isotretinoin therapy for acne vulgaris. Arch
Dermatol.2006 ;142(8):1016-22.
Castrichini M, Lazzerini PE, Gamberucci A, Capecchi PL, Franceschini R, Natale M,
Hammoud M, Moramarco A, Zimbone S, Gianchecchi E, Montilli C, Ricci G, Selvi E,
Cantarini L, Galeazzi M, Laghi-Pasini F. The purinergic P2×7 receptor is expressed
on monocytes in Behçet's disease and is modulated by TNF-α. Eur J Immunol. 2013
Sep19.