Receiver operating characteristic analysis was performed to calculate the cut-off value of serum cathelicidin associated with the occurrence of acne. The area under the curve was 0.866 (95% confidence interval was 0.790–0.942). The best cut-off value of serum cathelicidin for the occurrence of acne was 10.95 ng/ml, with a sensitivity of 81.7% and specificity of 86.7% (Fig. 5).
Further support is also shown by previous reports suggesting a possible beneficial role for vitamin D in acne. Sebocytes were demonstrated as vitamin D-responsive target cells 8, where binding of vitamin D to vitamin D receptors stimulates proliferation and inhibits differentiation as well as lipid synthesis by sebocytes 35. In addition, vitamin D decreased the production of inflammatory biomarkers, especially IL-6, IL-8, and MMP-9, by cultured sebocytes 36. Moreover, Zhang et al.37 demonstrated that vitamin D inhibits monocyte/macrophage proinflammatory cytokine production by targeting mitogen-activated protein kinase phosphatase-1.
In the same context, a study reported that a signaling lipid, sphingosine-1-phosphate, generated by sphingosine kinase 1, regulates cathelicidin expression through a nuclear factor-κβ-dependent pathway, independent of vitamin D receptor in epithelial cells 42.
Limitations to our study include the greater number of female patients compared with male patients. This could be attributed to female patients being more concerned with their beauty, and therefore more keen in seeking medical advice for acne. In addition, BMI was not measured, representing a limitation to our work. Another limitation is that cathelicidin levels were only measured in serum and not in tissue.
There are no conflicts of interest.
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