Exploring Trace Metal Imbalances: Serum Levels of Zinc, Selenium, Copper, Lead, Cadmium, and Mercury, and their Ratios in Acne Vulgaris Patients: An Analytical Cross-sectional Study.

Abstract

Background: Acne vulgaris is one of the most problematic skin disorders among young adults with evolving etiopathogenesis. The study aimed to determine the correlation between serum levels of copper (Cu), zinc (Zn), selenium (Se), lead (Pb), mercury (Hg), cadmium (Cd), and Cu/Pb, Cu/Hg, Cu/Cd, Cu/Se, and Cu/Zn ratios in patients of acne vulgaris.

Patients and methods: In our study, we enrolled 139 acne vulgaris patients as cases and 86 normal adults as controls. Using the global acne grading system (GAGS score), these cases were categorized into mild (n 1 = 32), moderate (n 2 = 82), and severe (n 3 = 25). Venous blood samples of all study participants (aged 15-25 years) were examined for serum levels of zinc, copper, selenium, lead, mercury, and cadmium using inductively coupled plasma mass spectrometry (ICPMS). SPSS.21 version software was used for the analysis of data.

Results: We noted statistically significant ( P value < 0.001, student's t test) difference in mean serum levels of Cu, Zn, Se, Pb, and Hg (microgram/liter) between cases and controls denoted as 2773.60 ± 1234.45 vs.1672.10 ± 696.70, 904.19 ± 644.48 vs.1621.50 ± 554.80, 175.24 ± 88.96 vs.292.86 ± 119.39, 0.84 ± 0.18 vs.0.10 ± 0.02, 2.61 ± 0.42 vs.1.99 ± 0.72, respectively. Serum Cd was undetectable in all the study participants. Low levels of serum Cu, and Cu/Se ratio and high levels of Pb, Hg, Cu/Hg, and Cu/Pb ratios were associated with the severity of acne vulgaris ( P value < 0.001). A significantly low Cu/Zn ratio was observed in cases compared to controls.

Limitations: Small sample size and non-assessment of the method of cooking.

Conclusion: Low levels of Zn and Se, and high levels of Pb and Hg could play a crucial role in the etiopathogenesis of acne, especially in moderate to severe cases. Copper, which, although elevated overall in acne cases, was found to be lower in severe cases compared to mild and moderate cases.