الفهرس 
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Abstract
Acne Vulgaris is a common skin disorder worldwide, affecting all ages and races. It is characterized by pimples, scaly red skin, blackheads, whiteheads, pinheads and large papules. Although multiple factors contribute to acne development, chronic inflammation is an important mechanism. Vitamin D plays a role in regulating immune system, proliferation and differentiation of keratinocytes and sebocytes. It has antioxidant and anti-comedogenic properties. So, vitamin D deficiency has a positive role in pathogenesis of acne vulgaris. The aim of the present study was to: assess frequency of serum vitamin-D deficiency among studied acne patients, the effect of vitamin-D supplementation on acne grading and to highlight the effect of vitamin D supplementation on patients’ Dermatological Quality of Life DQOL. This study was conducted on acne patients who were recruited from dermatology outpatient clinics, Menoufia University Hospital, Egypt in the time frame from January 2018 to May 2021.
The sample size was calculated to be 78 acne patients, Based on their previous medical history; certain acne patients were excluded from the study
The studied acne patients who accepted to participate in the study and fulfilled the exclusion criteria were selected from a total of 230 acne patients attended the dermatology clinic during period of data collection.
The study was conducted on two phases; the first phase was cross-sectional study to assess frequency of vitamin D deficiency among acne cases and its effect on patients’ DQOL.
The severity of acne vulgaris was assessed by clinical examination according to: Tutakne grading system for acne
Patients were interviewed by using the following tools:
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I-Questionnaires
1) - Self designed questionnaire about general medical history, history of exposure to risk factors for vitamin D deficiency and Measuring socioeconomic standard.
2) - A questionnaire to measure the effect of acne vulgaris on patient dermatological quality of life.
II- General and local dermatological clinical examination:
A- General examination to detect signs associated with vitamin D deficiency.
B- Local dermatological examination to assess the severity of acne according to: Tutakne acne grading system.
Blood samples were withdrawn from acne patients, then patients with vitamin D deficiency (66 patients) were divided into two groups to start the second phase of the study as a case control study. The case group (33 patients) were treated with Oral vitamin D for 2 months besides regular treatments of acne. The control group (33 patients) received traditional treatment for acne without vitamin D supplementation. Both groups were followed up clinically after two months. The control group received vitamin D supplementation after the follow up stage of the study for ethical considerations. Digital photos for acne lesions before and after treatment were obtained from participants after having their written consent The study revealed the following results:
Frequency of vitamin D deficiency among the studied acne patients was 82.5%.
Regarding general characteristics of acne in the studied cases: mean age of onset 22.8±5.9, progressive course (48, 8%). Acne was exaggerated mainly by menses (23, 8%), and to less extent by eating chocolate (8, 8%) and exams (3, 8%). Cases were receiving acne treatment for a mean duration of 3.9±4.3 months.
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Regarding Comparison between acne cases with and without vitamin D deficiency as regard sociodemographic characteristics: there was significant difference between the two studied group as regard sex, residence and socioeconomic standard, P< 0.05
Vitamin D deficiency was significantly more prevalent among female acne patients (98.4%) and among urban resident patients (51.5%).
Regarding Risk factors for Vitamin D deficiency there was significant relation between vitamin D deficiencies, sun exposure and milk intake per day.
Regarding Comparison between the two studied groups as regards frequency of symptoms associated with Vitamin D deficiency bony aches, recurrent infections, fatigue and dyspeptic symptoms were significantly more frequent among acne patients with vitamin D deficiency.
Regarding comparison between cases with and without vitamin D deficiency as regard total score of dermatological quality of life there was significant effect (p= 0.001) of acne vulgaris on patients’ dermatological quality of life, about 35% of patients with acne and vitamin D deficiency had moderately affected DQOL.
There was a significant negative correlation between acne grade and serum level of vitamin D.
A statistically significant relationship was found between serum vitamin D level and severity of acne vulgaris and between the mean level of vitamin D and grade of acne vulgaris among the studied group.
There was significant improvement in acne grading where about 60% of acne patients treated with vitamin D supplementation reached stage zero of acne. Also no patients treated with vitamin D supplementation have acne grade III or IV.