{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T08:04:16Z","timestamp":1783065856146,"version":"3.54.6"},"reference-count":21,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Acne vulgaris is a chronic inflammatory skin disease influenced by systemic immune responses. While isotretinoin is the most effective treatment for severe acne, its effects on hematological markers of inflammation, in particular red cell distribution width (RDW)\u2010to\u2010lymphocyte and RDW\u2010to\u2010platelet ratios, remain unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study analyzed 450 acne patients treated with isotretinoin for at least 24\u2009weeks. Hematological parameters, including complete blood count (CBC) indices, RDW\u2010derived ratios, neutrophil\u2010to\u2010lymphocyte ratio (NLR), and monocyte\u2010to\u2010lymphocyte ratio (MLR), as well as biochemical markers (ALT, AST, ALP) and clinical measures (lesion counts, Global Acne Grading Score [GAGS], Dermatology Life Quality Index [DLQI], SF\u201036, and Hospital Anxiety and Depression Scale [HADS]) at baseline and weeks 8, 16, and 24.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Isotretinoin treatment was associated with significant reductions in systemic inflammatory markers, including WBC count, NLR, and MLR, while lymphocyte count increased (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The ratios of RDW to lymphocytes and RDW to platelets also decreased over time (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Liver enzymes remained stable. Clinical assessments showed significant improvements in acne severity, quality of life, and mental health scores (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Adverse events were reported in 90.7% of patients, with musculoskeletal symptoms and constipation more common than previously reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study highlights the systemic immunomodulatory effects of isotretinoin, particularly the significant changes in RDW\u2010derived ratios, suggesting their potential as novel inflammatory markers. These findings reinforce the broader effects of isotretinoin beyond sebaceous gland suppression and support its role in the regulation of systemic inflammation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.70108","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T07:22:15Z","timestamp":1741764135000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Systemic Anti\u2010Inflammatory Effects of Isotretinoin: Evaluation of Red Cell Distribution Width to Lymphocyte and Platelet Ratios as New Hematological Markers and Clinical Outcomes in Acne Vulgaris"],"prefix":"10.1111","volume":"24","author":[{"given":"Abdullah","family":"Demirbas","sequence":"first","affiliation":[{"name":"Department of Dermatology Kocaeli University Faculty of Medicine  Kocaeli Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gozde Uluta\u015f","family":"Demirbas","sequence":"additional","affiliation":[{"name":"Department of Dermatology Kocaeli City Hospital  Kocaeli Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esin","family":"Diremsizoglu","sequence":"additional","affiliation":[{"name":"Department of Dermatology Kocaeli University Faculty of Medicine  Kocaeli Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gizem","family":"Islamoglu","sequence":"additional","affiliation":[{"name":"Private Clinic  Konya Turkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1702493"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.15668"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2008.03.020"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/15569527.2024.2423257"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1080\/15569527.2020.1734815"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.15199"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/15569527.2023.2268166"},{"issue":"1","key":"e_1_2_10_9_1","first-page":"63","article-title":"A Novel Inflammatory Marker in the Follow\u2010Up of Moderate\u2010To\u2010Severe Acne Vulgaris Administered Isotretinoin: Systemic Immune\u2010Inflammation Index (SII)","volume":"48","author":"Turan \u00c7.","year":"2022","journal-title":"Current Health Sciences Journal"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.15532"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/exd.12971"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2012.10949.x"},{"key":"e_1_2_10_13_1","first-page":"9","article-title":"Effects of Systemic Isotretinoin Treatment on Hemogram, Biochemical Parameters, and Inflammatory Markers","volume":"58","author":"O\u011fuz I. D.","year":"2024","journal-title":"TURKDERM\u2014Turkish Archives of Dermatology and Venereology"},{"key":"e_1_2_10_14_1","first-page":"65","article-title":"Is Mean Platelet Volume an Inflammatory Marker in Acne Patients Treated With Isotretinoin?","volume":"28","author":"Tamer F.","year":"2019","journal-title":"Acta Dermatovenerologica Alpina, Panonica et Adriatica"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00403-024-03434-x"},{"issue":"2","key":"e_1_2_10_16_1","first-page":"89","article-title":"Effects of Isotretinoin on the Inflammatory Markers and the Platelet Counts in Patients With Acne Vulgaris","volume":"35","author":"Se\u00e7kin H. 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