Hematological parameters in patients with acnes

To compare complete blood count (CBC) parameters and inflammatory factors in the patients with different grade of acne vulgaris and healthy controls.

many conditions. 14 Novel biomarkers of CBC parameters for inflammation have been the subject of extensive studies, but few studies have evaluated the relationship between acne vulgaris and CBC parameters. Therefore, the aim of the current study was primarily to conduct a further extensive study to compare CBC parameters and IFs in the patient with different grades of acne vulgaris and healthy controls (HCs).

| Study subjects
Twenty outpatients diagnosed with acne were included from June 2022 to August 2022, 10 patients with mild acne and 10 patients with moderate-to-severe acne. In addition, 10 healthy controls were recruited. All enrolled patients were diagnosed by two specialist dermatologists according to acne severity (Table 1). In cases of discrepancy, state of patients was assessed by a third independent dermatologist and consensus derived.
Individuals aged 18-60 years with acne, who did not present other dermatology disorders and had not taken antibiotics, were included in this study. Exclusion criteria were are as follows.
1. Patients with other causes of inflammatory response, including seborrheic dermatitis, psoriasis, and inflammatory arthritis.
2. Patients with a history of drug use in the 2 months before inclusion, including the use of antibiotic and other anti-acne drugs.
3. Patients were considered to be in the immunocompromised state. 4. Pregnant or lactating patients were excluded.

| Study methods
Questionnaires were used to collect demographic and clinical details. Two peripheral blood samples (4 mL total) were collected via the cubital vein in the patients and HCs by EDTA tubes. One tube of samples was used for complete blood count analysis which were completed by the Clinical Laboratory Department, and the another one was used for inflammatory factors detection. Serological levels of IFs were detected by enzyme label analyzer RaytoRT-6100, Rayto Co. Ltd, China, using enzyme-linked immunosorbent assay kits (96 T, JiuBang Biology, China) according to manufacturer's protocols.

| Statistical analyses
Numerical variables were presented as Mean ± SD (standard deviation) Kolmogorov-Smirnov test and Shapiro-Wilk test were used to statistical. One-way ANOVA was utilized for data analysis, followed by Bonferroni's test. Correlation analysis was performed using the Pearson's correlation assay. Statistical analyses were performed with SPSS 24 software (IBM SPSS statistics 23) and the R statistical package. A p value <0.05 was considered statistically significant.

| Patients' characteristics
Thirty Participants total were finally included in this study, with a median age of 22 years. Detailed characteristics of the study population were presented in Table 2. There were no significant differences in basic characteristics including age (p = 0.580), gender (p = 1.000), BMI (p = 0.331), family history (p = 0.530), time for sleep (p = 0.630), and constipation (p = 0.660) among the three groups.

| Comparison of CBC parameters
The results of CBC parameters were shown in the following Table 3.

Grade of acne Classification Criteria
Mild Level I, Comedones were predominant, a small number of papules and pustules, the total number of lesions less than 30.

Moderate
Including level II and level III. Level II: pimples, papules and pustules of equal amount, and the total number of lesions ranged from 31 to 50; level III: a large number of papules and pustules, and occasionally large inflammatory lesions, which were widely distributed. The total number of lesions ranged from 51 to 100, with less than 3 nodules.
Severe level IV, the main lesion was nodular/cyst acne or clustered acne; the total number of lesions was more than 100, and the number of nodules/cysts was more than 3.

| Comparison of the Serum levels of IFs
Serum levels of inflammatory factors among the three groups were summarized in Table 4. The expression of TNFα, IL-6, IL-8, and IL-1α was different in each group (all p < 0.05). The inflammatory factors of the moderate-to-severe group were significantly higher than the other two groups (p < 0.05). Compared to the health controls, TNFα, IL-6, IL-8, and IL-1α of the patients with mild acne were significantly higher (p < 0.05).

| CBC parameters and the Serum levels of IFs
Pearson correlation analyses were carried out to detect any corre-

| DISCUSS ION
In this study, we compared the CBC parameters and inflammatory factors between patients with the different acne grades and HCs, and we found that CBC parameters were not significantly elevated in patients with acne compared to healthy controls. However, studies have found that the levels of inflammatory factors in acne patients were significantly elevated relative to HCs and increased with the severity of acne. The results of our study showed that CBC parameters did not have the potential to distinguish the severity of acne, and the detection of inflammatory factor levels is more hopeful to become an effective clinical means for the objectively judgment of the severity of acne.
Acne is a chronic inflammatory disease of follicular sebaceous unit. The pathogenesis is complex, 15  with advanced gastric cancer (GC). In addition, it has been reported that NLR and PLR were found to be predictive markers of lymph node metastasis of GC patients, and NLR is better to predict overall survival than PLR. 22 The study by T Gambichler et al 11

| LI M ITATI O N
The limitations of this study include that this is a single-center study with a small sample size, which may lead to a certain deviation of the study results. A multicenter study with a large sample size should be conducted in the future to determine whether the CBC parameters and related IFs can be used as inflammatory markers of acne.

AUTH O R CO NTR I B UTI O N S
The study was designed by JC and TC. Samples were collected by TC, YC, and LL. Processing of the specimens was performed by JC and YL. The data were analyzed by TC and YP. The manuscript was written by TC, YC, and XS. All the authors reviewed and approved the final manuscript before submission.

FU N D I N G I N FO R M ATI O N
This study was supported by the National Natural Science Foundation of China (n82073462).

CO N FLI C T O F I NTE R E S T S TATE M E NT
All authors declare no potential conflicts of interest, including any relevant financial interests, activities, relationships, or affiliations.

DATA AVA I L A B I L I T Y S TAT E M E N T
The data that support the findings of this study are available from the corresponding author upon reasonable request.

E TH I C A L A PPROVA L
This study was approved by the Ethics Committee of the First Affiliated Hospital, Chongqing Medical University (ID: 2022-83).