Kurdistan Region Government- Iraq

Ministry of Higher Education and Scientific Research

Erbil polytechnic University

Soran Technical Institute

Medical lab techniqueDepartment

EVALUATION OF SERUM LEVEL OF ZINC (ZN)

IN PATIENTS WITH ACNE VULGARIS
WITH DIFFERENT GENDER & AGE.

A Thesis
Submitted to the Medical lab technique Department Soran-Technical
instituteIn partial fulfillment of the requirements
for degree of Diploma in Medical lab technique

BY:
1- Banaz mshir omer 2- Dlvin omer abubakir
3- Helen hakim nabi 4- Shahen dler Arab
5- Sirat jawad maghdid

SUPERVISOR
ASSIST.LECTURER. AHMED S.IBRAHIM
B.Sc., M.Sc., MEDICAL MICROBIOLOGY

2723K 2023C 1444H

 Approval of the Graduate School/institute of Technical Sciences

I certify that this thesis satisfies all the requirements as a thesis for the degree of
diploma science

____________________
Jabar H. Adey
Head of Department

This is to certify that we have read this thesis submitted by Helen hakim nabi, Dlvin
omer abubakir, Shahen dler Arab, Sirat jawad maghdid, Banaz mshir omer
- Evaluation of serum level of zinc (zn) in patients with acne vulgaris with
different gender andage - that in our opinion it is fully adequate, in scope and
quality, as a thesis for the degree of Diploma of science.

___________________
Ahmed S. Ibrahim
Supervisor

III
Examining Committee Members
Asst. ____________________

Asst. ____________________

Asst. ____________________

IV
Abstract
Background: Acne vulgaris is a chronic inflammatory disease of the skin
that affects the individuals of all ages, especially adolescents. An
association between serum Zinc levels and acne vulgaris have been
reported in some studies. There is increasing evidence on the association
between low serum zinc levels and acne vulgaris; there are some reports
on Zinc level and severity of acne vulgaris. The aim of the study was to
measure the level of serum zinc in patients with acne vulgaris.
Objective: The aim of current study was to estimate serum zinc level in
patients with acne vulgaris and healthy subjects .
Materials and Methods:
This study was conducted at Ashti Teaching Hospital, Soran city,
Kurdistan Region - Iraq, throughout the period from the 1st of October to
the 30th of February 2023. It was a case-control study Design, in which
30 patients with acne vulgaris and 30 apparently healthy controls without
acne vulgaris were enrolled. The two groups were matched for age, sex.
Levels of serum zinc were measured.
Results: the acne patients exhibited a lower zinc level (70.47+7.15 9μg/l)
than did the normal controls (110.34 +17.9μg/l) and the difference
between two groups was significant (P=0.001).
Conclusions: Determining serum trace element levels in acne patients is
necessary and an easy method, and that prescribing trace element
supplement treatments for patients with low serum trace element levels
may help increasing the success rate of acne treatment.
Low level of serum zinc has been found in patient with acne vulgaris
especially those with severe form of the disease, but there is no relation
between low serum zinc levels and the severity of the acne vulgaris.

Keywords: acne vulgaris, Serum trace element (Zinc), Global acne

grading

V
 List of Contents

Contents Page
Title page
Certification and approval pages I
Committee Marks and signature II
Abstract III
List of contents IV-V
List of Table and Figure VI
List of abbreviation VII
Orde
r
Chapters Page
Chapter one: Introduction & Review of Literature
1 Introduction 1
1.1. The anatomy of the skin 1
1. 2 Literature review 4
1.2. 1 Acne Vulgaris 4
1.3 Types of acne 4
1.4. Categories of acne 6
1.5 Causes of cystic acne 7
1.5.1 Hormones 7
1.5.2. Bacteria 7
1.5.3. Diet 8
1.5. 4. Cosmetics 8
1.5. 5. Drugs 8
1.6. Diagnosis & symptoms of cystic acne 9
1.7. Treatment of acne 9
1.7.1 Resorcinol 9
1.7.2. Benzoyl Peroxide 10
1.7.3. Salicylic Acid 10
1.7.4. Sulfur 10
1.7.5. Retin-A 10
1.7.6. Azelaic Acid 10
1.7.7. Topical antimicrobials 10
1.8. Role of Some Trace Elements in Pathogenesis of Acne 10

VI
Chapter Twe: Materials and Methods
2.1 Subjects, Samples, Chemicals 12
2.1.1 Study design 12
2.1.2 Assessment of zinc status 12
2.1.3. Sample collection 12
2.1.4. Biochemical Measurements 12
Chapter Three: Results
3.1 General characteristics of participants 14
3.2 Serum levels of Zinc (Zn) 14
3.6 Severity of patient acne (according GAGS) 16

Order Chapters Page

Chapter Four: Discussion 17
Chapter 5. Conclusions and Recommendations
5.1 Conclusions 18
5.2 Recommendations 19
References 20
‫ثوختة‬ 24

VII
 List of table and Figures
Page
Table 1-1 The global acne grading system 7
Table 3-1 General characteristics of participants 14
Table 3-2 The Mean Serum Levels of Zinc in Patients and Control 14

Figure 1-1 Diagram of the skin anatomy 1

Figure 1-2: Types of Acne 6
Figure 1-3: Types of Acne 7
Figure 1-4: Diagram of Nodulocystic Acne Below the Skin 8
Figure 3-1: Comparison of zinc level between acne and non-acne patient. 15
Figure (3-2) Distribution of patients with acne vulgaris 16

VIII
IX
 Chapter One Introduction &Literature review

1.1 Introduction
Acne is a chronic skin condition that affects many people every year.
This skin disorder has a high incidence and prevalence amongst all age
groups. Cystic acne is a severe form of acne that causes unpleasant cysts
on the face, chest, neck, back, or behind regions of the body and can lead
to disfigurement. Determining a treatment for this form of acne may be
an extensive and difficult process depending on the patient’s response to
initial treatments. Because of this, researchers have discovered and
developed many forms of treatments for cystic acne from systemic
therapy to light therapy. The goal of this thesis is to discuss the basis of
cystic acne and to evaluate the diverse treatments that are currently
available [ Ramos-e-Silva et al., 2015].

1.1.The anatomy of the skin

In order to understand the genesis of acne, one must first understand the
anatomy of the skin and the components that allow acne to form. The
anatomy of the skin is broken down into three main layers: the epidermis,
dermis, and subcutaneous tissue. These layers are listed from most
superficial to the deepest layer. (Figure 1-1).

Figure 1-1: Diagram of the skin anatomy

1
 Chapter One Introduction &Literature review

The epidermis layer, the outermost skin layer that can be easily observed,
contains the sensory nerve endings as well as the pore openings and hair
shaft .One of the main functions of the epidermis layer is to be the first
line of protection from ultraviolet light, infections, and prevent
detrimental damage to the integumentary system .This layer does not
contain blood vessels or capillaries, but it does contain four to five layers
of keratinized, stratified squamous epithelium. The keratin proteins
within the epidermis skin cells assist in protection as well as cell
migration, cell growth, transportation of resources, and recovery from
injuries. The dermis layer, which is the middle layer of the skin, is
constructed of two layers of connective tissue. The dermis contains the
nerve fibers with sensory nerve endings branching off of the fibers and
stretching into the top of the dermis layer, which is defined as the
papillary layer. The bottom layer of the dermis is the reticular layer,
which contains the majority of the appendages within the skin. The nerve
fibers and sensory nerve endings allow the body to feel sensations on the
skin whether the body is lightly touched or injured. The dermis layer also
includes capillaries and the erector pili muscles. The capillaries within
this layer provide the nutrients for the epidermis layer since that layer
does not have capillaries or blood vessels [McKinley et al., 2015]. The
erector pili muscles provoke the involuntary process that is observed as
the hair on our body to “standing up” and the skin may exhibit a goose
bump like texture when someone is cold or frightened. The most notable
appendages located within the dermis layer of the skin are the sweat
glands, sebaceous glands, and the hair follicles. The sweat glands are
responsible for releasing sweat through the sweat gland duct to the sweat
pore or hair follicle Sweating assists the body by excreting sweat in order
to cool the body down so that it does not overheat and cause damage

The sebaceous glands produce sebum, which is an oily secretion that is

released onto the hair or within the hair follicle. This release is motivated
by male and female sex hormones during puberty. Sebum assists in
keeping the skin from drying out, creating a waterproof barrier, and may
create a level complexion. However; an overproduction of sebum during
puberty and other points in the human life span where hormones are
produced in excess, such as menopause or pregnancy, may result in acne
[Chu, 2008]

2
 Chapter One Introduction &Literature review

The subcutaneous layer, the deepest layer of the skin, consists of

connective tissue such as areolar and adipose connective tissue, which
insulate the body The adipose tissue provides extra padding around the
bodies muscles and bones and it also assists in regulating the body’s
internal temperature by controlling whether or not heat is retained or
released from the body. The connective tissue within this layer is what
connects the integumentary system to the body’s muscles and bones. The
veins and arteries that travel through the integumentary system are also
located within the subcutaneous layer. The nerve cells from the dermis
layer extend through the subcutaneous layer and travel through the body
in order to relay information of touch and sensations to the brain
[McKinley et al., 2015].

Aim:
The present survey aimed to determine the relation of Zinc level
and adult people acne in Soran and occurance in different ages and
gender.

3
Chapter 1 Introduction &Literature review

1. 2 Literature review

1.2. 1 Acne

Acne is a chronic inflammatory disease of the pilosebaceous units,

characterized by comedones, papules, pustules, nodules, and often scars.
It affects primarily the face, neck, upper trunk, and upper arms. Acne
Vulgaris remain one of the most common dermatological condition
affecting the adolescents and young adults and is usually resolved by the
mid-twenties, and it is of multifactorial etiology (Christopher et al.,2016;
Fitzpatrick et al., 2013).
Even though considered as disease of teenage it may continue into the
30s and 40s in a minor proportion of the affected subjects (Zaidi, 2009).
Acne is a common manifestation of hyperandrogenemia. Numerous
factors contribute to the development of acne.
Androgenic stimulation of sebaceous glands is one of the important
factors in its development (Essah et al., 2006). The amount of excess
sebum production correlates with the severity of acne. Increased
sensitivity to androgenic hormones has also been reported to be a
contributing factor. The enzyme 5-alpha reductase converts testosterone
to the more potent androgen dihydrotestosterone within the sebaceous
glands (Shaw, 2002).
1.3. Types of acne
Acne is displayed in various forms depending on the causes and potential
hormone levels of an individual. Researchers have currently identified
multiple different types of acne. The simplest known form of acne lesion
is a comedo, which is a hair follicle that is clogged with sebum and dead
skin cells, and they are either an open or closed comedone. (Comedones
are the plural form of comedo). An open comedo is also known as a
blackhead and a closed comedo is known as a whitehead [Holzmann and
Shakery, 2014] .
Blackheads are clogged pores in the skin that have a dark colored
appearance. The dark color is not due to a buildup of dirt, but is a result
of the skin pigment melanin reacting with oxygen in the air because
blackheads are open comedones. Blackheads are difficult to extract from

4
Chapter 1 Introduction &Literature review

the skin because the dead skin cells, sebum, and acne causing bacteria
that make up this open comedo are not on the surface of the skin. A
whitehead is a closed comedo with a small yellow or whiteish oil-filled
bump. Whiteheads are easier to extract because the oil-filled bump is
easily popped by friction or pressure. Papules are a step up from
whiteheads. Papules are the typical inflamed pimple that most people
associate with acne, and they occur as small bumps across the affected
area. Another pimple or bump that is more serious than a papule is a
pustule. A pustule is a bump filled with yellow pus, and both papules and
pustules may be popped to release the bumps contents [ Zaenglein et al.,
2016].
A more severe type of acne that is more difficult to treat is nodular acne.
The nodules are inflamed painful, reddish bumps on the skin that may
feel like knots under the skin (. Nodules reach deep into the skin and
while they may have a whitehead, they usually cannot be popped and will
stay deep under the epidermis layer until the nodule is treated. Another
type of severe acne, which is the focus of this paper, is cystic acne. Cystic
acne is also an inflamed, red, and tender bump that reaches deep into the
skin’s layers, however; it occurs as cysts within the skin instead of
nodules This type of acne will be discussed in depth further into the
paper.
A form of acne that is less well known amongst the general population is
a severe form of acne known as acne conglobata. This type of acne
includes multiple irritated nodules that form a connection under the skin
and branch towards other nodules on the chest, neck, arms or the bottom
regions of those affected. Researchers have determined that this form of
acne may affect men more often because of steroid or testosterone usage,
and it may cause scarring [Tan et al. ,2013]
A more common form of acne is acne mechanica, which occurs due to
friction, pressure, and heat against the skin of the forehead due to
frequent use of sports helmets and baseball caps. Because the main
source of this form of acne is related to sports equipment, acne
mechanica is common amongst athletes, and they have been encouraged

5
Chapter 1 Introduction &Literature review

to use absorbent materials under their helmets or caps and to shower

shortly after wearing the equipment [Tan et al. ,2014]
1.4. Categories of acne
Dermatologists have narrowed down the types of acne to three different
categories based on the amount of whiteheads, blackheads, irritated
bumps, and lesions that occur on a person’s skin (Figures:1-2 , 1-3). The
first category of acne is mild acne, which consists of blackheads and/or
whiteheads. A patient with mild acne will have fewer or smaller pimples
than those with more intense acne, and therefore, mild acne will be easier
to treat and clear up than others
The second category of acne is moderate acne, which is normally treated
by a dermatologist with a prescription medication in order to reduce the
amount of lesions over time. A patient with moderate acne will have
more noticeable pimples as well as inflamed papules or pustules and this
form of acne will be more difficult to treat [ Ismail et al., 2012]
The third category of acne is known as severe acne, which consists of
papules, pustules, nodules, and cysts .This category of acne often leads to
the formation of acne scars because the types of acne involved are
stubborn and difficult to treat .In order to cure or reduce this form of
acne, it has to be treated by a dermatologist who in particular situations,
may prescribe strong topical or systemic acne treatments or sometimes
inject a corticosteroid into a targeted nodule or cyst in order to reduce the
inflammation [ Ismail et al., 2012].

Figure 1-2: Types of Acne

6
Chapter 1 Introduction &Literature review

Figure 1-3: Types of Acne

Table 1-1. The Global Acne Grading System (GAGS)

1.5. Causes of cystic acne
1.5.1. Hormones:
Common acne in teenagers starts with an increase in hormone
production. During puberty, both boys and girls produce high levels of
androgens, the male sex hormones that include testosterone. Testosterone
signals the body to produce more sebum, the oil produced by oil glands
of the skin [Dreno et al. ,2015]
1.5.2. Bacteria:
Excess sebum clogs the openings of hair follicles on the face, neck, chest,
and back allowing the bacteria to grow in these clogged follicles. This
causes blackheads or whiteheads, also known as ''comedones,'' to form on
the surface of the skin. Sometimes, this clogging causes the follicle wall
to break under the pressure of this buildup causing the sebum to leak into

7
Chapter 1 Introduction &Literature review

nearby tissues and forms a pustule or a papule which is inflammatory

acne. Larger, tender pustules are called nobules (Figure1-5[Dreno et
al. ,2015].

Figure 1-4: Diagram of Nodulocystic Acne Below the Skin

1.5.3. Diet:
Consumption of food having high glycemic index, dairy products, spicy
and oily food products exaggerates sebaceous glands activity leading to
acne. Smoking and alcohol consumption also leads to acne. A key factor
that may potentially play a role in the formation of acne for some patients
is their diet. Researchers are still debating on whether or not an increase
in sugar or sugary foods in a patient’s diet and an increase of insulin in
the bloodstream due to the amount of glucose ingested could lead to acne
formation .This increase in insulin could create an increase in the
production of endogenous sex hormones, such as testosterone and
estrogen, and therefore the cells within the sebaceous glands could be
stimulated and begin overproducing sebum, which may result in cystic
acne [Dreno et al. ,2015]
1.5. 4. Cosmetics: Excessive use of cosmetic products or silicon
containing products clogs the pore leading to formation of whiteheads.
Dead skin cells on the skin surface or dirt forms blackheads when mixed
with sebum. Scrubbing face vigorously or pricking pimple at this time
worsens the situation leading to scar formation [Danesh and Murase,
2015]
1.5. 5. Drugs: Prolonged use of some drugs burn the skin of that area
causing scar formation. The oral contraceptives, injectable
contraceptives, intrauterine birth control devices (IUD), Steroids taken by
bodybuilders and athletes may also cause acne. This abnormal sebum,
changes the activity of an usually harmless skin bacterium known as P.

8
Chapter 1 Introduction &Literature review

acnes, which becomes more aggressive and causes inflammation and

formation of pus. Though acne cannot be fully cured, but can be
controlled with proper treatment. [Danesh and Murase, 2015] .
1.6. Diagnosis & symptoms of cystic acne
Cystic acne is diagnosed by having the lesions inspected by a medical
professional such as a family medicine doctor, a dermatology physician
assistant, or most likely, a dermatologist. The medical professional will
observe the lesions and determine if they are cystic and also count the
other acne lesions (open and closed comedones, papules, pustules, and
nodules) to determine the degree of severity for treatment purposes. The
lesions observed may be on the back, chest, or face of the patient (Figure
1-6).
The superficial symptoms of cystic acne lesions are characteristically
described as red, painful to the touch, elevated bumps on the areas of the
body that are acne prone (face, chest, and back) . A cystic lesion is
normally accompanied by smaller lesions around the cyst, and therefore
causes the affected area to be painful or sensitive (. These lesions are also
more visible than less severe forms of acne, which may lead to self-
esteem issues over one’s appearance as well as a decline in mood. This
puts patients with cystic acne at a higher risk for psychological problems
and emotional distress than those with a less severe form of acne. Cystic
acne may also result in permanent damage to the skin by producing scars
in the form of either small, deep pits called “icepick scars,” shallow
depressions in the skin, larger pits, or red, raised scars [Zaenglein et al.,
2016)].
1.7. Treatment of acne
The treatment of acne depends on its severity and persistance. Treating
mild acne Acne can usually be treated with OTC (over-the-counter)
medications. Most acne OTC5 products may contain the following active
ingredients: [Trivedi et al. 2017]
1.7.1. Resorcinol: It is a crystalline phenol derived from various resins. It
helps in the breakdown of blackheads and whiteheads [Trivedi et al.
2017]
1.7.2. Benzoyl Peroxide: Benzoyl peroxide is a white crystalline powder
and acts as a peeling agent, helpful in clearing pores, reducing the
bacterial count in the affected area. Benzoyl peroxide kills bacteria and
slows down oil production from glands [Trivedi et al. 2017]

9
Chapter 1 Introduction &Literature review

1.7.3. Salicylic Acid: Salicylic Acid helps to break down the blackheads
and whiteheads, reduces shedding of cells which line the follicles of the
oil glands and is effective in treatment of inflammation and swelling. It
helps the epidermis to shed skin more easily, prevents pores from
becoming blocked and at the same time allows new cells to grow [Trivedi
et al. 2017]
1.7.4. Sulfur: Sulfur, in its native form, is a yellow crystalline solid. It
helps to break down blackheads and whiteheads [Trivedi et al. 2017]
1.7.5. Retin-A: It helps to unplug blocked pores. Retin-A contains
Tretinoin, an acid from of vitamin A, also known as all-trans retinoic acid
(ATRA). It acts as a chemical peel and checks skin aging [Rademaker,
2016]
1.7.6. Azelaic Acid: It is a saturated dicarboxylic acid found naturally in
wheat, rye, and barley. Azelaic acid strengthens the cells that line the
follicles, stops oil eruptions and reduces bacterial growth and
inflammation. It is useful for patients with dark skin, dark patches on face
(melasma) and persistent brown marks from acne [Rademaker, 2016]
1.7.7. Topical antimicrobials - Topical antimicrobials (clindamycin,
erythromycin, and sodium sulfacetamide) are used in patients with
moderate to severe acne [Rademaker, 2016].
1.8. Role of Some Trace Elements in Pathogenesis of Acne
Vulgaris
Trace elements are essential to biochemical processes in the body and are
involved in immunological and inflammatory reactions. The
keratinization and melanin formation are enzyme-dependent processes
and could be influenced by the deficiencies and excesses of trace
elements. Zinc is involved in the destruction of free radicals through
cascading enzyme systems. Zn is an integral part of as many as 40
metalloenzymes, including Zn superoxide dismutase with antioxidant and
anti-inflammatory activity. [Lynch et al., 2001]. )
Zinc is also a structural component of many hormones such as growth
hormone, insulin, sex hormones and thymulin and influences the activity
of these hormones. Meat and fish products are the best sources of
nutrition for zinc content and bioavailability.
The zinc in food of animal origin is absorbed better than zinc in food of
grain origin. The phytates present in grains bind zinc and decrease its
absorption. Zinc deficiency is a common mineral deficiency in our

10
Chapter 1 Introduction &Literature review

country where 70-80% of the daily calorie requirement is derived from

grains and grain products.(Wong et al., 2001)
Zinc deficiency can be due to genetic or acquired causes. Genetic zinc
deficiency leads to “acrodermatitis enteropathica”, characterized by red,
patchy and scaly dermatitis involving the face, periorificial and
anogenital regions, papulopustular, psoriasiform or vesiculobullous
eruptions of the acral regions, and alopecia. Acquired zinc deficiency can
be associated with alcoholism, chronic diseases, malabsorbtion due to
jejunoileal bypass and consumption of food with a high phytate content
such as some high-fiber vegetable and grains The acne-like
papulopustular lesions in zinc deficiency and their rapid improvement
with zinc supplementation have led some investigators to assess the
relationship between serum zinc levels and acne. These studies are few in
number but have shown that patients with acne have low serum zinc
levels although these levels do not correlate with the severity of disease.
Some authors have therefore combined zinc to inflammatory acne
treatment, and it is still used with varying rates of success.(Katzman &
Logan, 2007)(Dreno et al., 2005).

11
Chapter 2 Materials and Methods

2. Materials and Methods

2.1 Subjects, Samples, Chemicals

2.1.1 Study design:

The study was carried out on 30 (16females &14 males) acne

vulgaris patients without treatment for acne vulgaris who were recruited
randomly from different department of college of Education /Salahaddin
University. The diagnosis of those patients has been performed under
supervision of a specialist physician in Dermatology deportment. The
patients age who involved in this study ranged from 18- 25 years. Thirty
apparently healthy individuals matched in age and gender were also
included as controls.
2.1.2 Assessment of zinc status
Definition of zinc status was as follows (WHO, 1995; Al-Timimi.et al.,
2005):
Severe zinc deficiency: serum zinc concentration <50μg/dl.
Marginal zinc deficiency: serum zinc concentration 50-70 μg/dl.
Normal zinc level: serum zinc concentration between 70-130μg/dl.
High zinc level: serum zinc concentration >130μg/dl.
2.1.3. Sample collection
After overnight fasting for 12-14hours, blood sample had been collected
from participants. For sera blood, samples were collected in BD
vacutainer system CAT-plain tuber (5ml), by using medical centrifuge at
3000 rpm (revolution per minute). The serum was separated for 10
minutes and then the serum had been stored at -28 ̊C for later analysis of
serum zinc, albumin and triglycerides.
2.1.4. Biochemical Measurements
Serum Zinc: Serum level of zinc was measured by spectrophotometer
using colorimetric procedure. The Kit was manufactured by LTA s.r.l.
via Milano 15/F ITALY Code CC02750.
Test summary
Zinc reacts with the chromogen present in the reagent forming a colored
compound which color intensity is proportional to the zinc concentration
present in the sample.

12
Chapter 2 Materials and Methods

Calculation:
In serum\plasma
Zn μg/dl = [A (sample) /A (standard)] × conc. of standard (200 μg/dl).

13
Chapter 3 Results

3. RESULTS

3.1 General characteristics of participants

The Table 3-1 shows that the gender of respondents where 26 out of 60
respondents which is equivalent 43.3% of the respondents were male and the
remaining 34 out of 60 respondents which is equivalent 56.7% were female.
As the below table determine, the age of the respondents, where the age of 18-20
in the percent of 65%, and the age of 21-23 in the percent of 26.7%. And the
remaining 8.3% were the age > 23 years. Therefore, this information identifies
that there were majority of respondents were the age of 18-20.
Table 3-1 General characteristics of participants
Frequency Percent Valid percent Cumulative Percent
Sex
male 26 43.3 43.3 43.3
female 34 56.7 56.7 100
Total 60 100 100
Age
18-20 39 65 65 65
21-23 16 26.7 26.7 91.7
>23 5 8.3 8.3 100
Total 60 100 100

3.1. Serum levels of Zinc (Zn)

Table (3-2), shows the mean (SD) values of serum Zn in patients with–
acne types and controls group. Concerning serum Zn levels in patients with acne
type where was a significant lower levels (70.47+7.15 mg. dl) than that of
healthy (110.34 +17.9 mg/dl, P=0.0001).

Table 3-2 The Mean Serum Levels of Zinc in Patients and Control
parameter patient Mean±SD Control Mean±SD P-Value
Zinc((μg/l) 70.47+7.15 110.34 +17.9 0.0001

14
Chapter 3 Results

Figure (3-1): Comparison of serum zinc level between acne and non-acne patient.

Figure (3-1) &Table (3-2) shows the results of Zinc levels in (serum)
samples of control and Acne Vulgaris patients. The results reflect a significant
increase (P=0.001) in the serum level of Zinc of Acne Vulgaris groups in
comparison to that of the control.Trace elements such as zinc is the most
common elements used in different forms of skin care products and therapeutic
purposes in dermatology and play an important role in the physiological
function of the body [Rayman ,2000; Akinboro et al.,2013]

3.2 Severity of patient acne (according GAGS)

15
Chapter 3 Results

The study includes 30 patients suffering from acne vulgaris and 30 apparently
healthy controls without acne lesions. The patients were divided clinically
according to the severity of disease as follows:
8(27%) patients with mild form of acne, moderate acne in 16(53%) and 6(20%)
with severe condition (Figure 3-2)

Figure (3-2) Distribution of patients with acne vulgaris

16
Chapter 4 Discussion

4. Discussion

Trace elements such as zinc is the most common elements used in

different forms of skin care products and therapeutic purposes in
dermatology and play an important role in the physiological function of
the body [Rayman ,2000; Akinboro et al.,2013]

In Egypt [El-Kholy et al., 1990], measured the serum levels of zinc

and copper in children with asthma and atopic dermatitis. They showed
that low zinc level was more significant in atopic dermatitis patients than
the healthy individuals in the control group. [Kaymak et al.] studied the
serum zinc level in patients with Acne Vulgaris. They measured the
serum level of zinc in 47 patients in the case group and 40 healthy
volunteers as controls. Their results showed that the serum levels of zinc
were lower in the acne vulgaris patients than in controls. [Mashaly et al.
2014] stated that the serum level of zinc in the pemphigus vulgaris
patients is considerably lower than the controls. Zinc plays an important
role in protein synthesis, gene expression, and transcription and is also an
essential trace element component in more than 250 metalloenzymes.
Zinc deficiency causes failure to thrive, immune deficiency, anorexia,
dermatitis, diarrhea, and allergic dermatitis [Kaymak et al., 2007; , Hardy
et al., 2009; et al.,2008]. Papet I. It has been stated that a seborrheic
dermatitislike rash can be produced by zinc deficiency in patients with
acrodermatitis enteropathica and acrodermatitis-like conditions
[Goldsmith et al.,2012]. In addition, Zinc plays an important role in
normal function of skin and hair and there is a correlation between serum
level of zinc and presence of diseases like acne vulgaris, wound healing,
and pustular psoriasis [Sehgal V et al.,2010].

Brocard et al stated that zinc is a cofactor of many

metalloenzymes, indicating its crucial role in cell proliferation and
regulation of the immune system. Their results also showed that zinc can
play a critical role not only in the regulation of adaptative immunity but
also in innate immunity, which playsa crucial role in the skin. They found
that zinc has an important role in the inflammatory process of
inflammatory diseases such as inflammatoryacne, acrodermatitis
enteropathica, hidradenitis suppurativa, and folliculitis decalvans
[Brocard et al.,2011].

17
Chapter 5 Conclusiona & Recommendation

5. Conclusions and Recommendations

5.1 Conclusions:

In this study, we explored that acne vulgaris patients have a

decreased serum concentration of trace elements when compared to the
healthy individuals. The study strongly suggests that reduced level of
serum trace elements, may contribute to the pathogenesis of acne vulgaris
and Trace element deficiency in the studied acne patients could be one of
the causes of acne.

18
Chapter 5 Conclusiona & Recommendation

5.2. Recommendations

From the present study we postulate that serum Trace element

levels are considerably at abnormal levels in acne vulgaris patients when
compared to controls in Thus, looking into our results and previous
research data from the literature it is advisable to have adjunctive Trace
element therapy (in the form of oral medication as well as in the daily
diet) for prevention and management of patients with acne.

19
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22
 ‫پوختە‬

‫زیپکە نەخۆشییەکی درێژخایەنی هەوکردنی پێستە کە تووشی تاکەکانی هەموو تەمەن ەکان دەبێت‬ ‫بة رايي و مةبةست ‪:‬‬
‫بەتایبەتی هەرزەکاران‪ .‬لە هەن دێک لێکۆڵین ەوەدا پەیوەن دی نێ وان ئاس تی زین ک ل ە س یرۆم و زیپک ە ڤولگاریس دا ڕاپ ۆرت‬
‫کراوە‪ .‬بەڵگەی زیادبوون هەیە لەسەر پەیوەندی نێوان ئاستی نزمیی زینکی سیرۆم و زیپک ە ڤولگ اریس؛ هەن دێک ڕاپ ۆرت‬
‫هەیە لەسەر ئاستی زینک و تون دی زیپک ە ڤولگ اریس‪ .‬ئام انج ل ە توێژینەوەک ە پێوان ەکردنی ئاس تی زینکی س یرۆم ب وو ل ە‬
‫نەخۆشانی تووشبوو بە زیپکە‪.‬‬
‫ئامانج ‪ :‬ئامانجی لێکۆڵینەوەکانی ئێستا خەماڵندنی ئاستی زینکی سیرۆم بوو لە نەخۆشانی تووشبوو بە‬
‫زیپکە و کەسانی تەندروست‪.‬‬
‫ئەم توێژینەوەیە لە نەخۆشخانەی ئاشتی فێرکاری‪ ،‬شاری سۆران‪ ،‬هەرێمی کوردستان ‪-‬‬ ‫ثيداويستيةكان و رَيطاكان‬
‫عێراق‪ ،‬بە درێژایی ماوەی لە ‪1‬ی تشرینی یەکەم تا ‪30‬ی شوباتی ‪ 2023‬ئەنجامدراوە‪ ،‬توێژینەوەیەکی کەیس‪-‬کۆنتڕۆڵ بووە‬
‫دیزاین‪ ،‬کە تێیدا ‪ 30‬نەخۆش تووشی زیپکە و ‪ 30‬نەخۆش بوون بەڕواڵەت کۆنتڕۆڵە تەندروستەکان بەبێ زیپکە ڤولگاریس‬
‫ناویان تۆمارکرا‪ .‬ئەو دوو گروپە بەپێی تەمەن‪ ،‬ڕەگەز هاوتا بوون‪ .‬ئاستی زینکی سیرۆم پێوانە کرا‪.‬‬
‫نەخۆشانی زیپکە ئاستی زینکیان کەمتر بوو (‪ )9μg/l 7.15+70.47‬لە چاو کۆنتڕۆڵە ئاساییەکان (‬ ‫ئەنجامەکان ‪:‬‬
‫‪ )17.9μg/l+ 110.34‬و جیاوازی نێوان دوو گروپەکە گرنگ بوو (‪.)P=0.001‬‬

‫‪ :‬دیاریکردنی ئاستی توخمە شوێنکەوتووەکانی سیرۆم لە نەخۆشانی زیپکەدا پێویستە و ڕێگەیەکی ئاسانە‪ ،‬و‬ ‫دەرەنجام ‪:‬‬
‫کە ڕێنماییکردنی چارەسەری تەواوکەری توخمە شوێنکەوتووەکان بۆ ئەو نەخۆشانەی کە ئاستی توخمە شوێنکەوتووەکانی‬
‫سیرۆمیان کەمە ڕەنگە یارمەتیدەر بێت لە زیادکردنی ڕێژەی سەرکەوتنی چارەسەری زیپکە‪.‬‬
‫ئاستی نزمیی زینک لە سیرۆمدا لە نەخۆشانی زیپکەدا دۆزراوەتەوە بە تایبەتی ئەوانەی کە فۆڕمی توندی نەخۆشیەکەیان‬
‫هەیە‪ ،‬بەاڵم هیچ پەیوەندییەک لە نێوان کەمی ئاستی زینک لە سیرۆم و توندی زیپکەدا نییە‪.‬‬

‫وشەی سەرەکی‪ :‬زیپکە ڤولگاریس‪ ،‬توخمە شوێنەواری سیرۆم (زینک)‪ ،‬پلەبەندی جیهانی زیپکە‬

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