MAGNITUDE AND ASSOCIATED FACTORS OF ZINC DEFICIENCY AMONG PATIENTS WITH ACNE VULGARIS: A CROSS-SECTIONAL STUDY
Abstract
Background: Zinc deficiency is one of the main health problems affecting many peoples in developing countries. The acne like papule pustular lesions in zinc deficiency and their rapid improvement with zinc supplementation have led to assess the relationship between serum zinc levels and acne.
Methods: the Facility-based cross-sectional study was conducted on 102 patients with acne vulgaris in Ayder Referral Hospital from March to April 2016. Individual dietary diversity score was determined as the sum of the number of food groups consumed in 24 hours prior to the study. Serum zinc concentration was determined using Flame Atomic Absorption Spectroscopy and zinc deficiency was defined at serum levels less than 70µg/dL. Logistic regression analysis was conducted to identify factors associated with serum zinc deficiency. Moreover, independent t-test and one-way ANOVA were done to compare the mean serum zinc level between different groups. The significance was declared at p< 0.05.
Results: The mean serum zinc concentration was 95.38 ± 20.95 µg/dL (95% confidence interval [CI]: 91.28 – 99.49) and 19.61% of the patients were zinc deficient. Higher prevalence of zinc deficiency was noticed in patients with acne who were regularly doing exercise (Adjusted odds ratio [AOR]=3.27; 95% CI: 1.211−8.20), drinking alcohol (AOR=3; 95% CI:1.95−11.00), consuming no meat (AOR = 4; 95% CI: 1.86−10.00) and taking milk (AOR = 5; 95% CI: 1.52−11.70). There was also a significant difference in mean score of serum zinc level among groups who experience diarrhea; women with regular menses; with cereal, vegetable, and meat consumption; and acne duration.
Conclusion: The prevalence of zinc deficiency was higher among patients with acne vulgaris in the hospital. Regular exercise, no meat consumption, high alcohol and milk intake were factors associated with zinc deficiency. Clinicians should consider serum zinc level and the contributing factors while diagnosing and treating patients with acne vulgaris.
Downloads
References
2. Trumbo P, Yates AA, Schlicker S, Poos M. Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. J Am Diet Assoc. 2001;101:294−301.
3. Gibson RS. Zinc nutrition in developing countries. Nutr Res Rev. 1994;7:151−73.
4. Gibson RS. Principles of nutritional assessment. Oxford University Press, USA; 2005.
5. International Zinc Nutrition Consultative Group (IZiNCG), Brown KH, Rivera JA, Bhutta Z, Gibson RS, King JC, et al. International Zinc Nutrition Consultative Group (IZiNCG) technical document#1. Assessment of the risk of zinc deficiency in populations and options for its control. Food Nutr Bull. 2004;25:S99−203.
6. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ, Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360:1347−60.
7. Harbige LS. Nutrition and immunity with emphasis on infection and autoimmune disease. Nutr Health. 1996;10:285−312.
8. Aggett PJ. Physiology and metabolism of essential trace elements: an outline. Clin Endocrinol Metab. 1985;14:513−43.
9. Puertollano MA, Puertollano E, de Cienfuegos GA, de Pablo MA. Dietary antioxidants: immunity and host defense. Curr Top Med Chem. 2011;11:1752−66.
10. Bogino EA, Kebede MG, Kahsay AB. Acne at Ayder referral hospital among patients attending the dermatologic clinic, Mekelle, Northern Ethiopia. SJCM. 2014;3:129−34.
11. Fried RG, Gupta MA, Gupta AK. Depression and skin diseases. Dermatol Clin. 2005;23:657−64.
12. Vora S, Ovhal A, Jerajani H, Nair N, Chakrabortty A. Correlation of facial sebum to serum insulinlike growth factor1 in patients with acne. Br J Dermatol. 2008;159:990−1.
13. Aesoph LM. A holistic approach to skin protection. Nutrition Science News. 1998;3:204−8.
14. Boelsma E, Hendriks HF, Roza L. Nutritional skin care: health effects of micronutrients and fatty acids. Am J Clin Nutr. 2001;73:853−64.
15. Katzman M, Logan AC. Acne vulgaris: nutritional factors may be influencing psychological sequelae. Med Hypotheses. 2007;69:1080−4.
16. Dreno B, Foulc P, Reynaud A, Moyse D, Habert H, Richet H. Effect of zinc gluconate on propionibacterium acnes resistance to erythromycin in patients with inflammatory acne: in vitro and in vivo study. Eur J Dermatol. 2005;15:152−5.
17. Niren NM, Torok HM. The Nicomide Improvement in Clinical Outcomes Study (NICOS): results of an 8-week trial. Cutis. 2006;77:17−28.
18. Pohit J, Saha KC, Pal B. Zinc status of acne vulgaris patients. J Appl Nutr. 1985;37.
19. Verma KC, Saini AS, Dhamija SK. Oral zinc sulfate therapy in acne vulgaris: a double-blind trial. Acta Derm Venereol. 1980;60:337−40.
20. Michaelsson G. Zinc therapy in acrodermatitis enteropathica. Acta Derm Venereol. 1974;54:377−81.
21. Dreno B, Moyse D, Alirezai M, Amblard P, Auffret N, Beylot C, et al. Multicenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus minocycline hydrochloride in the treatment of inflammatory acne vulgaris. Dermatology. 2001;203:135−40.
22. Hillström L, Pettersson L, Hellbe L, Kjellin A, Leczinsky CG, Nordwall C. Comparison of oral treatment with zinc sulfate and placebo in acne vulgaris. Br J
Dermatol. 1977;97:681−84.
23. Göransson K, Lidén S, Odsell L. Oral zinc in acne vulgaris: a clinical and methodological study.Acta Derm Venereol. 1978;58;443−8.
24. Lidén S, Göransson K, Odsell L. Clinical evaluation in acne. Acta Derm Venereol. 1980;89:47−52.
25. Pierard GE, Pierard-Franchimont C. Effect of a topical erythromycin-zinc formulation on sebum delivery. Evaluation by combined photometricmulti-step samplings with Sebutape. Clin Exp Dermatol. 1993;18:410−3.
26. Bae YS, Hill ND, Bibi Y, Dreiher J, Cohen AD. Innovative uses for zinc in dermatology. Dermatol Clin. 2010;28:587−97.
27. Piérard-Franchimont C, Goffin V, Visser JN, Jacoby H, Piérard GE. A double blind controlled evaluation of the Sebosuppressive activity of the topical erythromycin-zinc complex. Eur J Clin Pharmacol. 1995;49:57−60.
28. Orris L, Shalita A, Sibulkin D, London SJ, Gans EH. Oral zinc therapy of acne.Absorption and clinical effect. Arch Dermatol. 1978;114:1018−20.
29. Dreno B, Amblard P, Agache P, Sirot S, Litoux P. Low doses of zinc gluconate for inflammatory acne. Acta Derm Venereol. 1989;69:541−543.
30. Michaelsson G, Juhlin L, Vahlquist A. Effects of oral zinc and vitamin A in acne. Arch Dermatol. 1977;57:31−6.
31. Sandstead HH. Causes of iron and zinc deficiencies and their effects on the brain. J Nutr. 2000;130:347S-349S.
32. Michaelsson G, Vahlquist A, Juhlin L. Serum zinc and retinol-binding protein in acne. Br J Dermatol. 1977;96:283−86.
33. Getahun Z, Urga K, Ganebo T, Nigatu A. Review of the status of malnutrition and trends in Ethiopia. Ethiop j health dev. 2001;15:55−74.
34. Kaymak Y, Adisen E, Erhan M, Celik B, Gurer MA. Zinc Levels in patients with acne vulgaris. J Turk Acad Dermatol. 2007;1:71302a.
35. Rostami MM, Safavi AN, Maleki N, Soflaee M. Correlation between the Severity and Type of Acne Lesions with Serum Zinc Levels in Patients with Acne Vulgaris.Biomed Res Int. 2014;2014:474108.
36. Saleh BO, Anbar ZNH, Majid AY. Role of Some Trace Elements in Pathogenesis and Severity of Acne Vulgaris in Iraq Male Patients. J Clin Exp Dermatol Res. 2013;4:169.