Saliva May Be a Novel Diagnostic Tool for Monitoring Inflammation in Acne Vulgaris

mouth swab saliva
Testing with cotton swab in open mouth for covid-19, close-up.
The researchers’ goals were to assess the serum and salivary levels of interleukin-1 beta and C-reactive protein in patients with acne vulgaris.

Patients with moderate to severe acne vulgaris have significantly higher serum and salivary levels of C-reactive protein (CRP) and interleukin-1 beta (IL-1β) compared with control individuals, researchers reported in a study published in the Journal of Cosmetic Dermatology.

The case-control study included 189 participants — 84 patients with moderate to severe acne vulgaris and 105 apparently healthy age-, sex-, and body mass index (BMI)-matched individuals as a control group. Enzyme-linked immunosorbent assay was used to estimate serum and salivary levels of CRP and IL-1β.

Patients had a mean age of 19.26±1.52 years, and 46.4% were boys or men. Control participants had a mean age of 18.92±2.81 years, and 52.4% were boys or men. Patients had a mean age of acne vulgaris onset of 13.43±3.6 years, and the mean duration was 4.7±2.3 years. Postacne scarring was observed in 67.8% patients, and their mean Global Acne Grading System (GAGS) score was 32.78±6.9.

The study authors found that serum and salivary levels of CRP and IL-1β in the patients were significantly higher than the levels in the control participants (P <.001). Patients had a mean serum CRP level of 1.31±0.85 mg/L vs 0.46±0.32 mg/L for control participants and a mean salivary CRP level of 2.59±1.17 mg/L vs 0.92±0.16 mg/L for control participants. Patients had a mean serum IL-1β level of 886.65±953.3 pg/L vs 343.78±276.3 pg/L for control participants, and a mean salivary IL-1β level of 2097.68±2061.18 pg/L vs 886.58±574.71 pg/L for control participants.

The serum and salivary CRP levels had a significantly positive correlation with each other and with GAGS scores and serum IL-1β (P <.001). Serum IL-1β had a significant correlation with salivary IL-1β and with GAGS scores (P <.001). However, the levels of IL-1β in saliva did not have a significant correlation with GAGS scores or with serum and salivary CRP.

The investigators noted that their study included only patients with moderate to severe acne vulgaris and did not include patients with mild acne cases.

“The current study supports the emerging role of saliva as a valid noninvasive tool for monitoring inflammation and as a reliable and stress-free tool to evaluate cytokines and other inflammatory markers levels in acne vulgaris,” the researchers concluded.


Monib KME, El-Fallah AA, Salem RM. Inflammatory markers in acne vulgaris: saliva as a novel diagnostic fluid. J Cosmet Dermatol. Published online May 18, 2021. doi:10.1111/jocd.14236