Abstract
There has been an increasing focus on the extent to which oxidative stress is involved in the pathophysiology of acne. The aim of this study is to investigate the effect of silymarin, N-acetylcysteine (NAC) and selenium in the treatment of acne vulgaris. A randomized prospective clinical trial was carried out on 56 patients of both sexes with age range of 14-35 years who attend to outpatient clinic in Al-Hussein Teaching Hospital, Karbalaa, Iraq over a period from December 2011 to May 2012, all patients examined clinically by dermatologist and classified according to disease severity. Serum levels of glutathione (GSH), malondialdehyde (MDA) and interleukine-8 (IL-8) in the acne patients were measured by using ready-for-use Elisa kits, and compared to that of 28 healthy volunteers. The clinical follow up was done every two weeks in order to assess the changes in the number of inflammatory lesions. Administration of antioxidants silymarin, NAC and selenium (but not placebo) to patients with acne vulgaris significantly reduced serum MDA and increased serum GSH levels after 8 weeks compared to pre-treatment value; also significantly reduced serum IL-8 levels and the number of inflammatory lesions in patients with acne compared to placebo. The results obtained in this study clearly showed the beneficial effect of using silymarin, NAC and selenium to patients with acne vulgaris as indicated by the clinical improvement and biochemical findings, and confirmed the role of new strategy in the targeting of pathophysiological changes accompanied with acne by using antioxidant agents.

Key words: Acne vulgaris; Inflammation; N-acetylcysteine; Oxidative stress; Selenium; Silymarin