Clinical and Immunological Response to Doxycycline Versus Doxycycline Plus Vitamin C in Patients with Acne Vulgaris
Objective: Study the influence of doxycycline versus doxycycline with vitamin C drugs in the management of acne vulgaris on some immunological parameters which include ( IL-1β, IL-8, IFN-γ, TNF-α, and TLR2) and the following objectives were adapted: 1-Selection of population for the study ( control, patients) groups and follow up the patients after one month of treatment, the first group receive doxycycline and the second group receive doxycycline with vitamin C,2- Blood samples collection and separation of serums for immunological analysis, 3- Statistical analysis. Methods: This study is a randomized clinical trial carried out in clinical dermatology in Merjan Medical City in Babylon from September 2018 to March 2019. The number of subjects enrolled in the present study was 60; their age was between (14- 30 years), among whom 30 were acne patients, the remaining 30 subjects were apparently healthy individuals, and they were served as control. A dermatologist diagnosed a total of 30 acne patients to having moderate to severe acne and divided into two groups (15 patients in each group). Patients in the first group were treated with doxycycline (100mg) once daily after meal for 30 days, while in the second group patients were treated with doxycycline (100mg) capsule once daily after a meal in combination with vitamin C (500mg) chewable tablets once daily. After 1-month of therapy, the response was evaluated clinically and immunologically by measure the concentration of pro-inflammatory cytokines (IL-8, IL-1β, IFN-γ, TNF-α) and ( TLR-2 ) by using enzyme-linked immunosorbent assay (ELISA) and the results were compared to their levels before treatment and that in the control group. Results: Significant elevation in the serum levels ( p ≤ 0.001) of immunological parameter IL-8, IL-1β, IFN-γ, TNF-α, and TLR-2 among acne patients in comparison to the control. The clinical response in the first group was good, moderate and poor in 5 (33%), 7(47%) and 3(20%) respectively, while in the second group was good, moderate and poor in 7 (47%), 7(47%) and 1(6%) respectively, the immunological results showed that the serum levels to the (IL-1β, IL-8, IFN-γ, TNF-α) and (TLR-2 ) were more reduced in the second group compared to their levels in the first group. Conclusion: Significant elevation (p less than 0.001) in the serum levels of (IL-8, IL-1β, IFN-γ, TNF-α, and TLR-2) among moderate to severe acne patients in comparison to control group. Clinically the combination of doxycycline plus vitamin C was more efficient as therapeutically in comparison to doxycycline alone. Immunologically doxycycline plus vitamin C was more effective in reducing serum levels of (IL-8, IL-1β, IFN-γ, TNF-α, and TLR-2) in comparison to doxycycline alone.