Journal of

Hyaluronic acid (HA), the main and most important constituent of extracellular matrix, is a glycosaminologycan with water-absorbing capacity found in large amount in growing and repairing tissues. One of the main causes of skin problems, particulary in aging skin, is HA deficiency. More than half of the body HA is in the skin and is necessary for the maintenance of internal matrix and several cellular functions. Filler gels containing HA are used to repair skin defects. As these substances are derived from animals and bacteria, not the human, may cause skin reactions and have short half-life. So efforts to maintain and/or increase HA secretion from skin fibroblasts are important in the prevention and treatment of skin aging.

Skin injury caused by burns, surgery and other traumas may result in unpleasant psychological experiences and be reflected in behaviors. Extracellular matrix (ECM) is the largest component of natural skin which is gel-like and is produced by skin cells. ECM synthesis is a key factor for filling up skin wounds such as burns, leishmaniasis, chicken pox, acne, etc. ECM is composed of a variety of polysaccharides, water, and collagen proteins. Considering its weight, natural skin strength and its expandability are like steel, while it has high elasticity and compaction capacities. These characteristics are due to dual effects of main ECM molecules, which are secreted by fibroblasts and epidermal cells: 1) structural fiber proteins like: elastin, fibronectin and laminin which give strength and flexibility to ECM, and 2) proteoglycans such as dermatan sulfate and hyaluronic acid which are consisted of few glycosaminoglycan chains that branch out from a linear protein core. Proteoglycans are large and hydrated molecules which are resistant to external forces and protect underneath cells. In general, understanding the skin structure and wound healing phases can help us to design useful experiments and to conduct proper researches in this area.

Background and Aim: Acne vulgaris is a common skin disease and oral isotretinoin is the only  treatment that is dramatically effective on its severe type The aim of this study was to evaluate the effects of oral Isotretinoin on the level of sex hormones and menstrual cycle in female patients with severe acne.

Methods: In this before and after treatment study, 50 patients with severe acne vulgaris whom were referred to the dermatology clinic of Amir-Almomenin Hospital in Tehran  in 2015 and 2016, were recruited. The inclusion criteria were female gender, age between 18 to 50 years, and having severe acne. Exclusion criteria were: pregnancy, lactating, and suffering from other diseases which could confound the study results. The prescribed dose of the oral isotretinoin was 0.5 mg/kg/day for three months. Before initiation of treatment and  after three months of treatment serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), estradiol, and total and free testosterone were measured and compared.

Results: The mean ± standard deviation (SD) age of the patients was 26.0 ± 7.1 years, and 10% of them had polycystic ovary syndrome (PCOs). After taking isotretinoin, 33 (66%) of patients had no change in their menstrual periods, while 3 (6%) had oligomenorrhea, 4 (8%) had amenorrhea, and 10 (20%) had dysmenorrhea. After treatment, mean serum LH levels significantly increased (P=0.001), but FSH, estradiol, and total and free testosterone serum levels did not change statistically (P>0.05).

Conclusion: This study showed that oral isotretinoin can increase the level of serum LH and cause changes in menstrual cycles.