Original articleRetinoic acid 4-hydroxylase inducibility and clinical response to isotretinoin in patients with acne
Section snippets
Participants
This study was approved by the University of Michigan Medical School Institutional Review Board and conducted in accordance with the Helsinki Declaration. The study was conducted in the Program for Clinical Research in Dermatology at the University of Michigan. Written informed consent was obtained from participants before enrollment. Healthy individuals were enrolled to investigate normal CYP26 expression (N = 118) and CYP26 induction by tRA (N = 29). Healthy individuals were defined as not
CYP26 enzymatic activity is variable in normal-appearing human skin
We first assessed basal (constitutive) CYP26 enzymatic activity in normal-appearing human skin (82 men and 36 women). The age range of participants was 19 to 62 years, with a mean age of 35.9 ± 0.9 years. CYP26 enzymatic activity, as determined by formation of 4-hydroxy RA, ranged from 1 to 180 pg/min/mg total epidermal microsomal protein, with a mean level of 42.7 ± 3.5 pg/min/mg total epidermal microsomal protein (Fig 1). There was no significant difference (P = .29) in enzymatic activity
Discussion
Isotretinoin, or 13-cis RA, is the most effective medication for severe acne. Despite its use for decades, the mechanism of this drug is not fully understood. Current evidence suggests that isotretinoin may affect many of the factors involved in acne pathogenesis, such as androgenic activity, sebum production, bacteria, and inflammation. Indeed, 13-cis RA has been shown in vitro to decrease androgen production.12 Isotretinoin also decreases sebocyte proliferation and differentiation, and more
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Drs Wang and Kwak contributed equally. Drs Wang and Kang accept responsibility for the scientific integrity of the work described in this article.
Supported by grants 5T32 AR007197 (Dr Wang) and 1K24 AR02159-01 (Dr Kang) from the National Institutes of Health, Bethesda, MD; and the Babcock Research Endowment, University of Michigan, Ann Arbor.
Conflicts of interest: None declared.