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Abstract

Background: Post-acne hypertrophic scars and keloids result from abnormal wound healing within the pilosebaceous unit. Ruptured microcomedones create wounds that can lead to prolonged inflammation, increased collagen synthesis, and fibrinolysis inhibition, resulting in elevated scar tissue in acne lesions. Vitamin D deficiency can lead to prolonged inflammation and damage to dermal collagen. High total cholesterol levels can lead to excessive sebum production, exacerbating inflammation and fibrosis. This study aimed to determine the association between serum vitamin D and total cholesterol levels with scar severity in patients with post-acne hypertrophic scars and keloids.

Methods: This analytical cross-sectional study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, South Sumatera, Indonesia, among patients who met the inclusion and exclusion criteria. Scar severity was assessed using the Vancouver Scar Scale (VSS). Blood samples were collected for examination of serum vitamin D and total cholesterol. The data were analyzed statistically.

Results: Chi-square test of serum vitamin D with VSS scores showed a significant association (p-value = 0.007), while total cholesterol with VSS showed no association (p-value = 1.000). Odd-ratio (OR) for serum vitamin D and VSS was 60, concluding that vitamin D deficiency increased the risk of high VSS by 60-fold in study patients.

Conclusion: There was a significant association between serum vitamin D levels and VSS score, while there was no association between total cholesterol and VSS score. Deficiency of serum vitamin D is associated with a higher risk of developing a higher VSS score in patients with post-acne hypertrophic scars and keloids.

References

  1. Goodarzi A, Behrangi E, Ghassemi M, Nobari NN, Sadeghzadeh-Bazargan A, Roohaninasab MJ. Acne scar; A review of classification and treatment. JCR. 2020;7(7):1108–14.
  2. Goh C, Cheng C, Agak G, et al. Acne vulgaris. In: Kang S, Amagai M, Bruckner A, et al., editors. Fitzpatrick’s dermatology. 9th ed. New York: McGraw-Hill; 2019. p. 1391–418.
  3. Agrawal DA, Khunger N. A morphological study of acne scarring and its relationship between severity and treatment of active acne. J Cutan Aesthet Surg. 2020;13(3):210–6.
  4. Fahy CMR, Lovell CR. Acquired disorders of dermal connective tissue. In: Griffiths C, Barker J, Bleiker TO, Hussain W, Simpson RC, editors. Rook’s textbook of dermatology. 10th ed. Oxford: Wiley-Blackwell; 2024. p. 9448–53.
  5. James WD, Elston DM, Treat JR, Rosenbach M. Fibrous tissue abnormalities: Keloid. In: James WD, Elston DM, Treat JR, Rosenbach M, editors. Andrews’ diseases of the skin: Clinical dermatology. 13th ed. Philadelphia: Elsevier; 2020. p. 610–1.
  6. Perhimpunan Dokter Spesialis Kulit dan Kelamin Indonesia (PERDOSKI). Keloid. In: Siswati A, Rosita C, Triwahyudi D, et al., editors. Panduan praktik klinis bagi dokter spesialis dermatologi dan venereologi Indonesia. Jakarta: PERDOSKI; 2021. p. 405–7. Indonesian.
  7. Kurniawati Y. Patogenesis skar hipertrofik dan keloid. In: Murlistyarini S, Fitriyani NW, Dani AA, Norawati L, Kurniawati Y, Darmaputra IGN, editors. All about scar. Jakarta: ECG; 2024. p. 56–62. Indonesian.
  8. Tripathi S, Soni K, Agrawal P, Gour V, Mondal R, Soni V. Hypertrophic scars and keloids: A review and current treatment modalities. Biomed Dermatol. 2020;4(1):1–11.
  9. Wang ZC, Zhao WY, Cao Y, et al. The roles of inflammation in keloid and hypertrophic scars. Front Immunol. 2020;11:1–10.
  10. Akoh CC, Orlow SJ. A review of vitamin D and scarring: The potential for new therapeutics. J Drugs Dermatol. 2020;19(7):742–5.
  11. Ince B, Uyar I, Dadaci M. Effect of vitamin D deficiency on hypertrophic scarring. Dermatol Surg. 2019;45(2):274–9.
  12. Hahn JM, Combs KA, Powell HM, Supp DM. A role for vitamin D and the vitamin D receptor in keloid disorder. Wound Repair Regen. 2023;31(5):563–75.
  13. El Hadidi HH, Sobhi RM, Nada AM, AbdelGhaffar MMM, Shaker OG, El-Kalioby M. Does vitamin D deficiency predispose to keloids via dysregulation of koebnerisin (S100A15)? A case-control study. Wound Repair Regen. 2021;29(3):425–31.
  14. Kilmister EJ, Paterson C, Brasch HD, Davis PF, Tan ST. The role of the renin-angiotensin system and vitamin D in keloid disorder-A review. Front Surg. 2019;6:1–12.
  15. Handono K, Tanuwijaya LK, Fitri LE, Kalim H. The correlation between serum concentration of vitamin D with vitamin D receptor expression and disease activity in Indonesian patients with systemic lupus erythematosus: Preliminary study. J Trop Life Science. 2014;4(2):113–8.
  16. Ung CY, Warwick A, Onoufriadis A, et al. Comorbidities of keloid and hypertrophic scars among participants in UK Biobank. JAMA Dermatol. 2023;159(2):172–81.
  17. Palmer MA, Blakeborough L, Harries M, Haslam IS. Cholesterol homeostasis: Links to hair follicle biology and hair disorders. Exp Dermatol. 2020;29(3):299–311.
  18. Utami OC, Kurniawati Y, Diba S, Saleh IM. Correlation between serum lipid profile and acne vulgaris severity. J Phys Conf Ser. 2019;1246(1):1–8.
  19. Sruthi K, Chelakkot PG, Madhavan R, Nair RR, Dinesh M. Single-fraction radiation: A promising adjuvant therapy to prevent keloid recurrence. J Cancer Res Ther. 2018;14(6):1251–5.
  20. Cho YS, Lee J, Joo SY, Seo CH. Crosstalk among adipose tissue, vitamin D level, and biomechanical properties of hypertrophic burn scars. Burns. 2019;45(6):1430–7.
  21. Chew S, Gajjar T, Patel N, Patel M. Safety and efficacy of two botanical based topical anti-acne products in treatment of mild to moderate acne subjects. JDC. 2020;4(5):99–107.
  22. Park JW, Koh YG, Shin SH, et al. Review of scar assessment scales. Med Lasers. 2022;11(1):1–7.
  23. Thompson CM, Sood RF, Honari S, Carrougher GJ, Gibran NS. What score on the Vancouver Scar Scale constitutes a hypertrophic scar? Results from a survey of North American burn-care providers. Burns. 2015;41(7):1442–8.
  24. Rodian MS, Kurniawati Y, Prasasty GD. Hubungan antara kadar sebum, kolesterol total, dan LDL dengan keloid pasca akne [undergraduate thesis]. Palembang: Universitas Sriwijaya; 2022 [cited 2024 Nov 11]. Indonesian. Available from: https://repository.unsri.ac.id/82070
  25. Limandjaja GC, Niessen FB, Scheper RJ, Gibbs S. The keloid disorder: Heterogeneity, histopathology, mechanisms and models. Front Cell Dev Biol. 2020;8:1–26.
  26. Yang Y, Chen Z, Wu X, Liu W, Gao Z. Androgen-related disorders and hormone therapy for patients with keloids. CJPRS. 2022;4(1):44–8.
  27. Sugawara T, Nakagawa N, Shimizu N, Hirai N, Saijo Y, Sakai S. Gender- and age-related differences in facial sebaceous glands in Asian skin, as observed by non-invasive analysis using three-dimensional ultrasound microscopy. Skin Res Technol. 2019;25(3):347–54.
  28. Liu L, Xue Y, Chen Y, et al. Prevalence and risk factors of acne scars in patients with acne vulgaris. Skin Res Technol. 2023;29(6):1–9.
  29. Dominguez LJ, Farruggia M, Veronese N, Barbagallo M. Vitamin D sources, metabolism, and deficiency: Available compounds and guidelines for its treatment. Metabolites. 2021;11(4):1–33.
  30. Mamdouh M, Omar GA, Hafiz HSA, Ali SM. Role of vitamin D in treatment of keloid. J Cosmet Dermatol. 2022;21(1):331–6.
  31. Kotze J, Nortje E, Phulukdaree A, Fear MW, Wood F, Bester J. Unveiling the link: The potential roles of vitamin D in keloid pathophysiology. Exp Dermatol. 2025;34(2):1–13.
  32. Damanik VI, Putra IB, Ginting O. Correlation between serum 25-hydroxyvitamin D levels with keloid severity. Open Access Maced J Med Sci. 2019;7(1):65–7.
  33. Camera E, Picardo M. Lipids in serum and sebum. In: Zouboulis CC, Katsambas AD, Kligman AM, editors. Pathogenesis and treatment of acne and rosacea. Berlin: Springer; 2014. p. 305–13.
  34. Kurniawati Y, Rodian MS, Argentina F, Prasasty GD, Dalilah, Nathania A. Association between sebum, total cholesterol, and low-density lipoprotein (LDL) cholesterol levels with post-acne keloids. Cureus. 2023;15(8):1–8.
  35. Elsaie ML. Update on management of keloid and hypertrophic scars: A systemic review. J Cosmet Dermatol. 2021;20(9):2729–38.

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