medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2021-27-20-25medalphabet-2265Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИПрименение изотретиноина при среднетяжелых и тяжелых формах акне: актуальные рекомендацииIsotretinoin for moderate to severe acne: current recommendationshttps://orcid.org/0000-0002-5044-5265КругловаЛ. С.KruglovaL. S.

Круглова Лариса Сергеевна, д.м.н., проф., зав. кафедрой дерматовенерологии и косметологии

Москва

Kruglova Larisa S., DM Sci, professor, head of Dept of Dermatovenereology and Cosmetology

Moscow

kruglovals@mail.ruhttps://orcid.org/0000-0003-3437-5233ГрязеваН. В.GryazevaN. V.

Грязева Наталья Владимировна, к.м.н., доцент кафедрыдерматовенерологии и косметологии

Москва

Gryazeva Natalya V., PhD Med, associate professor at Dept ofDermatovenereology and Cosmetology

Moscow

tynrik@yandex.ruhttps://orcid.org/0000-0002-9954-2920СидоренкоЕ. В.SidorenkoE. V.

Сидоренко Елизавета Евгеньевна, врач-дерматовенеролог терапевтического отделения, ст. лаборант кафедры кожных и венерических болезней

Ростов-на-Дону

Sidorenko Elizaveta E., dermatovenerologist of Therapeutic Dept, senior laboratory assistant at Dept of Skin and Venereal Diseases 

Rostov-on-Don

liza_11.94@mail.ruФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента РоссииРоссияCentral State Medical Academy of the Administrative Department of the President of RussiaRussian FederationФГБОУ ВО «Ростовский государственный медицинский университет» Минздрава РоссииРоссияRostov State Medical UniversityRussian Federation202101112021027Дерматология (2)2025Copyright © Круглова Л.С., Грязева Н.В., Сидоренко Е.В., 20212021Круглова Л.С., Грязева Н.В., Сидоренко Е.В.Kruglova L.S., Gryazeva N.V., Sidorenko E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/2265

В статье представлены данные о патогенезе акне, механизмах выбора терапии, тактике назначения изотретиноина и дальнейшего ведения пациентов. Даны ответы на важные вопросы, касающиеся назначения адекватной суточной дозы и обязательности набора суммарной дозы, безопасности препаратов, содержащих изотретиноин. Кроме того, обсуждаются возможность назначения препаратов на основе витамина А (ретинола пальмитата) в больших дозах у пациентов с акне и связанные с этим нежелательные реакции. Статья иллюстрирована тремя клиническими примерами пациентов с диагнозом «акне» с описанием тактики ведения.

This article presents data on the pathogenesis of acne, the mechanisms of choosing therapy, the tactics of prescribing isotretinoin and further management of patients. Answers are given to important questions concerning the appointment of an adequate daily dose and the obligation to set of cumulative dose concerning the mandatory, the safety of drugs containing isotretinoin. In addition, the possibility of prescribing drugs based on vitamin A (retinol palmitate) in large doses in patients with acne and related adverse reactions is being discussed. The article is illustrated with three clinical examples of patients diagnosed with acne with a description of management tactics.

акнеизотретиноинадапаленвитамин Аэффективностьпрофиль безопасностиСотретacneisotretinoinadapalenevitamin Aefficacysafety profileSotretReferencesGollnick H. Acne and related disorders. In: Elzouki AY, Harfi HA, Nazer H, Oh W, Stapleton FB, Whitley RJ, eds. Textbook of Clinical Pediatrics. Berlin: Springer; 2012: 1447–1466.Gollnick H. Acne and related disorders. In: Elzouki AY, Harfi HA, Nazer H, Oh W, Stapleton FB, Whitley RJ, eds. Textbook of Clinical Pediatrics. Berlin: Springer; 2012: 1447–1466.Thlboutot D, Gollnick H, Bettoli V, et al. New insights Into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009; 60: S1–S50.Thlboutot D, Gollnick H, Bettoli V, et al. New insights Into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009; 60: S1–S50.Paugam C, Corvee S, Saint-Jean M, et al. Propionibacterium acnés phylotypes and acne severity: an observational prospective study. J Eur Acad Dermatol Venereol. 2017; 31: e398–e399.Paugam C, Corvee S, Saint-Jean M, et al. Propionibacterium acnés phylotypes and acne severity: an observational prospective study. J Eur Acad Dermatol Venereol. 2017; 31: e398–e399.Dreno B, Thiboutot D, Gollnick FI, et al. Antibiotic stewardship in dermatology: limiting antibiotic use in acne. Eur J Dermatol. 2014; 24: 330–334.Dreno B, Thiboutot D, Gollnick FI, et al. Antibiotic stewardship in dermatology: limiting antibiotic use in acne. Eur J Dermatol. 2014; 24: 330–334.Thiboutot D, Dreno B, Gollnick FI, et al. A call to limit antibiotic use in acne. Journal of drugs in dermatology: JDD. 2013; 12: 1331–1332.Thiboutot D, Dreno B, Gollnick FI, et al. A call to limit antibiotic use in acne. Journal of drugs in dermatology: JDD. 2013; 12: 1331–1332.Pulcini C, Gyssens IC. Flow to educate prescribers in antimicrobial stewardship practices. Virulence. 2013; 4: 192–202.Pulcini C, Gyssens IC. Flow to educate prescribers in antimicrobial stewardship practices. Virulence. 2013; 4: 192–202.Bikowski JB. Subantimicrobial dose doxycydine for acne and rosacea. Skinmed. 2003; 2: 234–245.Bikowski JB. Subantimicrobial dose doxycydine for acne and rosacea. Skinmed. 2003; 2: 234–245.Gollnick HP, Bettoll V, Lambert J, et al. A consensus-based practical and daily guide for the treatment of acne patients. J Eur Acad Dermatol Venereol. 2016; 30 (9): 1480–1490.Gollnick HP, Bettoll V, Lambert J, et al. A consensus-based practical and daily guide for the treatment of acne patients. J Eur Acad Dermatol Venereol. 2016; 30 (9): 1480–1490.Cunliffe WJ, van de Kerkhof PC, Caputo R, et al. Roaccutane treatment guidelines: results of an international survey. Dermatology. 1997; 194: 351–357.Cunliffe WJ, van de Kerkhof PC, Caputo R, et al. Roaccutane treatment guidelines: results of an international survey. Dermatology. 1997; 194: 351–357.Tan J, Knezevic S, Boyal S, Waterman B, Janik T. Evaluation of evidence for acne remission with oral isotretinoin cumulative dosing of 120–150 mg/kg. J Cutan Med Surg. 2016; 20: 13–20.Tan J, Knezevic S, Boyal S, Waterman B, Janik T. Evaluation of evidence for acne remission with oral isotretinoin cumulative dosing of 120–150 mg/kg. J Cutan Med Surg. 2016; 20: 13–20.Strauss JS, Rapini RP, Shalita AR, Konecky E, Pochi PE, Comite H, Exner JH. Isotretinoin therapy for acne: results of a multicenter dose response study. J Am Acad Dermatol. 1984; 10 (3): 490–496. https://doi.org/10.1016/s0190–9622(84)80100–0Strauss JS, Rapini RP, Shalita AR, Konecky E, Pochi PE, Comite H, Exner JH. Isotretinoin therapy for acne: results of a multicenter dose response study. J Am Acad Dermatol. 1984; 10 (3): 490–496. https://doi.org/10.1016/s0190–9622(84)80100–0European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. CC Zouboulis, N Desai, L Emtestam, RE Hunger, D Ioannides, I Juhász, Journal of the European Academy of Dermatology and Venereology. 2015. 29 (4), 619–644.European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. CC Zouboulis, N Desai, L Emtestam, RE Hunger, D Ioannides, I Juhász, Journal of the European Academy of Dermatology and Venereology. 2015. 29 (4), 619–644.Rademaker M. Making sense of the effects of the cumulative dose of isotretinoin in acne vulgaris. Int J Dermatol. 2016; 55: 518–523.Rademaker M. Making sense of the effects of the cumulative dose of isotretinoin in acne vulgaris. Int J Dermatol. 2016; 55: 518–523.Lehucher-Ceyrac D, de La Salmoniere P, Chastang C, Morel P. Predictive factors for failure of isotretinoin treatment in acne patients: results from a cohort of 237 patients. Dermatology. 1999; 198: 278–283.Lehucher-Ceyrac D, de La Salmoniere P, Chastang C, Morel P. Predictive factors for failure of isotretinoin treatment in acne patients: results from a cohort of 237 patients. Dermatology. 1999; 198: 278–283.Ballanger F, Baudry P, N’Guyen JM, Khammari A, Dreno B. Heredity: a prognostic factor for acne. Dermatology. 2006; 212: 145–149.Ballanger F, Baudry P, N’Guyen JM, Khammari A, Dreno B. Heredity: a prognostic factor for acne. Dermatology. 2006; 212: 145–149.Amichai B, Shemer A, Grunwald MH. Low-dose isotretinoin in the treatment of acne vulgaris. J Am Acad Dermatol. 2006; 54: 644–646.Amichai B, Shemer A, Grunwald MH. Low-dose isotretinoin in the treatment of acne vulgaris. J Am Acad Dermatol. 2006; 54: 644–646.Layton AM, Cunliffe WJ. Guidelines for optimal use of isotretinoin in acne. J Am Acad Dermatol. 1992; 27: S2–7.Layton AM, Cunliffe WJ. Guidelines for optimal use of isotretinoin in acne. J Am Acad Dermatol. 1992; 27: S2–7.Leyden J.J. et al. The use of isotretinoin in the treatment of acne vulgaris: clinical considerations and future directions. J Clin Aesthet Dermatol. 2014 Feb; 7 (2 Suppl): S3–S21.Leyden J.J. et al. The use of isotretinoin in the treatment of acne vulgaris: clinical considerations and future directions. J Clin Aesthet Dermatol. 2014 Feb; 7 (2 Suppl): S3–S21.Strauss J.S. et al. J Am Acad Dermatol. 2001; 45: 187–195. White GM. et al. Arch Dermatol. 1998; 134: 376–378.Strauss J.S. et al. J Am Acad Dermatol. 2001; 45: 187–195. White GM. et al. Arch Dermatol. 1998; 134: 376–378.James Q. Del Rosso. J. Clin. Aesthet. Dermatology. 2012; 5: 17–24. Nast A. et al. JEADV. 2012; 26 (1): 1–29.James Q. Del Rosso. J. Clin. Aesthet. Dermatology. 2012; 5: 17–24. Nast A. et al. JEADV. 2012; 26 (1): 1–29.Goodfield M.J.D. et al., British Journal of Dermatology 2010; 162: 1172–1179.Goodfield M.J.D. et al., British Journal of Dermatology 2010; 162: 1172–1179.Penniston K L, Tanumihardjo S A. The acute and chronic toxic effects of vitamin A. Am J Clin Nutr. 2006 Feb; 83 (2): 191–201.Penniston K L, Tanumihardjo S A. The acute and chronic toxic effects of vitamin A. Am J Clin Nutr. 2006 Feb; 83 (2): 191–201.Russell R.M. The vitamin A spectrum: from deficiency to toxicity. Am J Clin Nutr. 2000 Apr; 71 (4): 878–84.Russell R.M. The vitamin A spectrum: from deficiency to toxicity. Am J Clin Nutr. 2000 Apr; 71 (4): 878–84.Xin L., Yun-Feng C., et al. The inhibition of UDP-glucuronosyltransferases (UGTs) by vitamin A, Xenobiotica. 2017 May; 47 (5): 376–381.Xin L., Yun-Feng C., et al. The inhibition of UDP-glucuronosyltransferases (UGTs) by vitamin A, Xenobiotica. 2017 May; 47 (5): 376–381.Круглова Л.С. Акне ирозацеа. Под редакцией Кругловой Л.С. ГЭОТАР-Медиа. 2021. 207 с.Kruglova L.S. Acne and rosacea. Edited by L.S. Kruglova GEOTAR-Media. 2021. 207 p.Круглова Л.С., Грязева Н.В., Бондаренко В.В. Терапия и профилактика поствоспалительной пигментации акне у взрослых. Медицинский алфавит. 2021. № 9. С. 72–78.Kruglova L.S., Gryazeva N.V., Bondarenko V.V. Therapy and prevention of post-inflammatory acne pigmentation in adults. Medical Alphabet. 2021. No. 9. P. 72–78.

The authors declare that there are no conflicts of interest present.