الفهرس 
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Abstract
Acne vulgaris (AV) is a chronic inflammatory disorder of
sebaceous follicles, found primarily on the face and upper trunk (chest
and back). It is considered the most common skin disease, estimated
to affect approximately 80% of individuals between ages of 11 and 30
years. It is a pleomrphic disorder with multifactorial pathogenesis
There are four primary pathogenic factors which interact in a
complex manner to produce acne lesions, these factors are follicular
hyperkeratinization, excessive sebum production, hypercolonization
of the duct by Propionibacterium acnes and direct or indirect
inflammation.
Another fifth factor included in the pathogenesis, is matrix
metalloproteinases.
Propionibacterium acnes (P. acnes) are gram positive, anaerobic
diphtheroids that are part of the normal skin flora. It plays an
important role in the pathogenesis of acne vulgaris by triggering
proinflammatory mediators through activation of Toll-like receptors 2
(TLR2).
Homocysteine is a sulfur containing amino acid derived from
methionine. Once synthesized, it can be converted back to methionine
by 5-methyltetrahydrofolate reductase and methionine synthase using
cofactors such as vitamin B12 and folic acid.
Normal range of serum homocysteine is 10μmol/L and
hyperhomocysteinemia is characterized by an abnormaly high level of
homocysteine in the blood conventionally described as above 15
μmol/L.