الفهرس 
AcneOnly 14 pages are availabe for public view
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Abstract
Acne vulgaris, a chronic inflammatory disease of the pilosebaceous unit, is the
most common cutaneous disorder worldwide affecting up to 80% of adolescents and up
to 50% of adults. It is characterized by inflammatory papules, pustules, open and closed
comedones, cysts and nodules. Acne pathogenesis begins with abnormal keratinization
that causes impaction and distension of the lower portion of the infundibulum, forming
the comedone. Other factors include a complex interplay among sebum production, with
changes in lipid composition, hypersensitivity to androgen stimulation,
Propionibacterium acnes, and local inflammatory cytokines elaborated by the innate
immune system.
Reactive oxygen species released from the impacted damaged follicular walls
are thought to be the reason for the progress of the inflammation in the pathogenesis of
the disease. Nuclear factor erythroid 2-related factor 2 (NRF2) is a transcription
factor that in humans is encoded by the NFE2L2 gene. It is a basic leucine zipper (bZIP)
protein that regulates the expression of antioxidant proteins that protect
against oxidative damage triggered by injury and inflammation.
The current study aimed at evaluation of the possible role of NRF2 in the
pathogenesis of acne vulgaris through its immunohistochemical assessment in
inflammatory and non inflammatory acne compared to normal skin in addition of
correlating NRF2 expression with the clinical and pathological parameters of acne.
The study was carried out on thirty patients with acne vulgaris (AV) and 30 age
and sex matched healthy volunteers as a control group. They were selected from the
Dermatology Outpatient Clinic, Faculty of Medicine, Menofia University. All
participants were subjected to complete history taking and dermatological examination
through grading of acne. Three millimeters punch biopsy was taken from each patient
(inflammatory and non inflammatory) acne lesions of the arms, upper trunk and back
under deeply infiltrated local anesthesia. The biopsies were processed in Pathology
Department, Faculty of Medicine, Menoufia University. from each block, 2 sections
were cut, one was stained by haematoxylin and eosin for routine histopathological
examination, and the other one was stained immunohistochemically for the evaluation
of NRF2 expression.
Nrf2 was upregulated in cases than controls. This was demonstrated by higher
expression positivity, intensity and H score in cases (follicular, perifollicular epidermis
and dermis) than in controls. Also, the nuclear expression was higher in cases than in
controls.
Regarding epidermal expression of Nrf2 in the perifollicular epidermis, There
were higher positivity, Nuclear localization, intensity and H score in cases than controls
and in inflammatory than both (non inflammatory and control groups).
There were significant correlation between NRF2 expression positivity in the
perifollicular epidermis and early onset age, type of acne lesion (more in inflammatory
than comedonal), inflammatory severity (increased with increased severity),
perivascular inflammatory location and with inflammatory infiltrate (neutrophils,
plasma cells and histiocytes).
Summary
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There were significant correlation between NRF2 expression positivity in the
follicular epidermis and early onset age, type of acne lesion (more in inflammatory than
comedonal), inflammatory severity (increased with increased severity), perivascular
inflammatory location and with inflammatory infiltrate (plasma cells, histiocytes and
lymphocytes).
Nuclear H score of the perifollicular epidermis was correlated to age of onset
with high H score was associated with the younger age of onset, type of acne lesion
(more in inflammatory than comedonal) inflammatory severity (increased with
increased severity), perivascular inflammatory location and with inflammatory infiltrate
(neutrophils, plasma cells and histiocytes).
Cytoplasmic H score of the perifollicular epidermis was correlated to age of
onset with high H score was associated with the younger age of onset, type of acne
lesion (more in inflammatory than comedonal) inflammatory severity (increased with
increased severity), periadnexal inflammatory location and with inflammatory infiltrate
(neutrophils).
Nuclear H score of the follicular epidermis was correlated to age of onset with
high H score was associated with the younger age of onset, type of acne lesion (more in
inflammatory than comedonal) inflammatory severity (increased with increased
severity), periadnexal inflammatory location and with inflammatory infiltrate
(neutrophils, plasma cells and histiocytes).
Cytoplasmic H score of the follicular epidermis was correlated to type of acne
lesion (more in inflammatory than comedonal) and less with inflammatory infiltrate
(plasma cells).