The effect of isotretinoin combined with omega-3 fatty acids on lipid metabolism in acne vulgaris: A Randomized Controlled Trial

Backgroud :Acne vulgaris is a common chronic inflammatory skin disease, and its pathogenesis may related to dyslipidemia. Omega-3 fatty acids regulate lipid metabolism and reduce inflammation, but its effect on blood lipids in Acne vulgaris has not been reported yet.To study the serum lipid metabolomic differences between patients and healthy populations and to investigate the effects of isotretinoin combined with omega-3 fatty acids on serum lipid metabolism in the acne vulgaris. Methods : 46 acne vulgaris patients and 20 healthy controls were recruited from the Affiliated Hospital of Southwest Medical University from July 2020 to June 2021. The untreated patients were randomly allocated to receive oral isotretinoin combined with (AVP) or without (AVW) omega-3 for 6 months. Serum lipid metabolomics was analyzed by liquid chromatograph-tandem mass spectrometer (LC-MS). Statistical analysis of lipid metabolites was conducted by partial least squares discrimination analysis (PLS-DA). The correlation between differential lipid metabolites and disease severity indicators was tested by Spearman analysis. Metabolic pathways in AVW group were analyzed by the Kyoto encyclopedia of genes and genomes (KEGG) database. Results : The PLS-DA showed a clear separation of serum lipid metabolites between the healthy controls and acne vulgaris patients, AVW group showed a trend towards approaching the healthy controls. The lipid metabolite composition of the AVW group showed significant changes, with 245 differential metabolites identified before and after treatment (P < 0.05). The Spearman correlation showed a strong co-expression between the serum level of StE (20:5) (6.44 ± 0.33 vs.7.18 ± 0.22, P < 0.001) and the Global Acne Grading System score (R = 0.73, P < 0.001). The KEGG revealed 18 differential pathways before and after treatment in the AVW. Conclusion : Omega-3 fatty acids could improve lipid metabolism disorders and downregulate inflammation in acne vulgaris by influencing specific lipid metabolites, but the molecular mechanisms need further exploration. The detailed clinical trial protocol has been retrospectively registered with the ISRCTN Registry of Clinical Trials website (NO. ISRCTN31758284) on 2022/07/09.