الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Acne is currently understood as a chronic inflammatory disease
of the pilosebaceous unit, characterized by androgen-induced
increased sebum production, follicular hyperkeratinization,
inflammation and altered adaptive immune response. Bacterial
colonization by propionibacterium acnes definitely aggravates the
course of the disease in various manners, but its role as prerequisite of
the induction of acne is disputable.
The clinical features of acne include seborrhea (excess grease),
non-inflammatory lesions (open and closed comedones),
inflammatory lesions (papules and pustules), and various degrees of
scarring. Nodules and cysts comprise severe nodulocystic acne. The
distribution of acne corresponds to the highest density of
pilosebaceous units (face, neck, upper chest, shoulders, and back).
Grading the severity of acne as mild, moderate or severe is a useful
initial assessment. Mild disease comprises open and closed comedones
with sparse inflammatory lesions. In moderate acne, papules and pustules
are more numerous. Severe acne comprises extensive lesions, and may
include nodules and scarring.
The presence of higher androgen levels is important for the
development of acne lesions. However, the majority of acne patients
exhibit normal levels of circulating androgens, suggesting that the impact
of androgens on the development of acne lesions might be related to endorgan
sensitivity.
The ratio of second to fourth digit length (2D:4D) has been
hypothesized to reflect prenatal androgen exposure and an individual’s
sensitivity to androgens. Men have a longer fourth digit (ring finger)
relative to the second digit (index finger) than women.
Exposure to higher androgen levels through the prenatal period
is related to a lower 2D:4D ratio in both sexes. For instance, lower
2D:4D (male type) digit ratios were found in both females and males
with congenital adrenal hyperplasia compared with healthy same-sex
controls. Higher (female type) digit ratios are also found in XY males
with androgen insensitivity syndrome, and this may be an indicator of
their importance of end-organ sensitivity.
Prenatal androgen levels increase at the end of the first trimester
and affect a number of organ systems. The prenatal androgen peak
time period (between 13 and 15 weeks of gestation) coincides with
both the development of the sebaceous gland and digits giving the
idea to investigate the relationship between digit ratio and acne
vulgaris.
In this study, we aimed to evaluate second and fourth digit
length ratio (2D:4D) in acne vulgaris patients compared to controls,
and to assess the association of this ratio with clinical aspects
(duration, severity and age of onset) of that disease.
The current study was carried out on 521 patients with different
degrees of acne vulgaris severity selected from Dermatology
outpatient clinic, Faculty of Medicine, Menoufia University Hospital,
Mansoura Dermatology Hospital and during the period from
january2015 to December 2015, in addition to 231 age and sex
matched healthy volunteers as a control group. For all participants
through history taking, good general and dermatological examination
and second and fourth digit length measurement were done.
Age of acne patients(521)ranged from 16 to 26 years with a
mean age of 19.87± 4.487 years, while age of control subjects ranged
from 16 to 36 years with mean age of 19.54 ± 3.809 years. There were
352 females and 169 males. The control group included 63 males and
168 females. Statistically, there were non-significant differences
between patients and controls as regards to age and sex distribution.
Clinical severity of all acne cases, varied from mild (64
cases,12.3%), moderate (344cases ,66%) to severe 113 cases, 21.7%). Male
cases severity varied from mild (22 cases,13%), moderate(121
cases,71.6%) and severe (26 cases ,15.4%)., while in females cases severity
varied from mild (42 cases, 11.9%), moderate (223cases, 63.4%) to severe
(87 cases, 24.7%).
In our study, there were no significant differences between right digit
2D:4D ratio, left digit 2D:4D ratio and total digit 2D:4D ratio in male
patients and control subjects; however, female acne patients showed
significantly lower right digit 2D:4D ratio, left digit 2D:4D ratio and total
digit 2D:4D ratio when compared to their control females.
In male acne patients, there was significant positive correlation
between severity of acne lesion and right 2D:4D ratio, but
insignificant correlations were found regarding left and total 2D:4D
digit ratio.
There were significant negative correlations between right, left
and total 2D:4D ratio with disease duration.Concerning the age of
acne onset, no significant correlations were found between right, left
or total 2D:4D and age of onset of acne lesion.
In female acne patient group, there was significant negative
correlation between right, left and total 2D:4D digit ratio with disease
duration. Significant positive correlations reported between left and
total 2D:4D digit ratio with severity of acne (p<0.001, r=0.481;
P<0.001, r=0.197). No significant correlations were found between
right (P=0.223,r=-.0.065) 2D:4D ratio in female patients with acne
severity. Concerning age of onset in acne development, no significant
correlations could be detected between any of assessed digit 2D:4D
ratio (right, left and total) with age of onset of acne (p= 0.169,r=-
0.073; p=0.121, r=0.083 &p=0.874 ,r= -0.008) respectively.