الفهرس 
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Abstract
Summary Acne vulgaris is a common chronic inflammatory disorder of pilosebaceous units affecting mainly adolescents, though it may present at any age. The pathogenesis of acne is known to be multifactorial and includes the interaction of several factors: sebum over production, abnormal follicular keratinization, P. acnes proliferation, inflammation, in addition to hormonal and genetic factors. IGF-1 is a polypeptide protein hormone with endocrine, paracrine and autocrine effects. IGF1 is synthesized primarily in the liver, where its synthesis is GH-dependent. Insulin is a polypeptide hormone produced by the beta cells of the islets of Langerhans of the pancreas that controls the level of glucose in the blood. So, it is a central player in the metabolic system. We conducted this work to evaluate the role of insulin and IGF-1 in patients with acne vulgaris, Correlation between levels of insulin & IGF-1 with severity of acne lesions and measuring of serum levels of DHEA-S, Free testosterone and insulin resistance. This study was held on out-patient clinic of dermatology of Mansoura University Hospital on 40 adolescent and adult female patients with acne vulgaris of different severity who were diagnosed clinically (group A). Forty healthy female volunteers with matched age, sex and BMI served as controls (group B). For both groups, a detailed history was taken (age, sex, BMI, onset, course, duration of acne lesions, prior treatment for acne, smoking history and menstrual cycle), complete physical & dermatologic examination for each patient. Severity of acne lesions using the International Consensus Conference on Acne Classification System Pochi et al, 1991. Mild: Few to several comedones, papules, pustules and no nodules. Moderate: Several comedones, papules, pustules and few to several nodules. Severe: Numerous comedones, papules, pustules and many nodules. The age of studied patients ranged from 13-33 years with mean of 20.78 (SD=5.2) years with matched height, weight and BMI with controls. Glucose, IGF1 and insulin were measured by ELISA and correlated its level with the severity of acne lesions. Serum F. testosterone and DHEA-S were measured by ELISA. Also, insulin resistance index was calculated by HOMA-IR HOMA-IR=fasting blood glucose (mmol\l) x fasting insulin (micro IU) /22.5) The results of our study were summarized as the following:According to previous classification we found that 40% of our cases have acne Vulgaris with moderate severity 37.5% of them with mild and only 22.5% with severe acne. Serum insulin, plasma glucose, IGF-1, HOMA-IR and DHEA-S showed significantly higher concentrations in acne patients when compared to control subjects however, no significance difference between cases and controls regarding free testosterone. Serum insulin, HOMA-IR, serum IGF-1, F. testosterone & serum DHEA-S were significantly higher in severe patients in comparison to mild and moderate acne. Insulin was significantly positively correlated with HOMA-IR in both acne patients and control and significantly positively correlated with weight, BMI, IGF1 and severity in acne group. IGF1 showed significant positive correlation with weight, BMI, HOMA- IR and severity in acne group. Applying logistic regression for prediction of acne using BMI, HOMA-IR, IGF-1 and DHEA-S as covariates. Higher HOMA-IR, IGF-1, DHEA-S were associated with higher risk to develop acne in univariate analysis. Whereas, in multivariate analysis, only higher BMI, HOMA-IR and higher IGF-1 were associated with higher risk to develop acne.