medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2023-5-31-36medalphabet-3069Research ArticleСтатьиАлгоритм ведения пациентов с папуло-пустулезным акнеAlgorithm for managing patients with papulopustular acnehttps://orcid.org/0000-0002-5044-5265КругловаЛ. С.KruglovaL. S.

Круглова Лариса Сергеевна - доктор медицинских наук, профессор, проректор по учебной работе, заведующий кафедрой дерматовенерологии и косметологии, eLibrary SPIN: 1107–4372.

Москва

Kruglova Larisa S. - DM Sci (habil.), professor, vice-rector for academic affairs, head of Dept of Dermatovenereology and Cosmetology, eLibrary SPIN: 1107–4372.

Moscow

kruglovals@mail.ruhttps://orcid.org/0000-0002-4672-697XТамразоваА. В.TamrazovaA. V.

Тамразова Анаит Вардановна - аспирант кафедры дерматовенерологии и косметологии.

Москва

Tamrazova Anahit V. - postgraduate student of Dept of Dermatovenereology and Cosmetology.

Moscow

anaittamrazova@gmail.comhttps://orcid.org/0000-0003-3437-5233ГрязеваН. В.GryazevaN. V.

Грязева Наталья Владимировна - кандидат медицинских наук, доцент кафедры дерматовенерологии и косметологии.

Москва

Gryazeva Natalya V. - PhD Med, associate professor at Dept of Dermatovenereology and Cosmetology.

Moscow

tynrik@yandex.ruСтенькоА. Г.StenkoA. G.

Стенько Анна Германовна - доктор медицинских наук, профессор кафедры дерматовенерологии и косметологии ЦГМА Управления делами Президента РФ, заведующий косметологическим отделением ИПХК.

Москва

Stenko Anna G. - DM Sci (habil.), professor at Dept of Dermatovenereology and Cosmetology CSMAA Department of the President of Russia, head of Dept of Cosmetology Institute for PSC.

Moscow

stenko1@rambler.ruФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента Российской ФедерацииРоссияCentral State Medical Academy of the Administrative Department of the President of RussiaRussian FederationФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента Российской ФедерацииРоссияCentral State Medical Academy of the Administrative Department of the President of Russia; Institute for Plastic Surgery and CosmetologyRussian Federation20230105202305Дерматология (1)3136Copyright © Круглова Л.С., Тамразова А.В., Грязева Н.В., Стенько А.Г., 20232023Круглова Л.С., Тамразова А.В., Грязева Н.В., Стенько А.Г.Kruglova L.S., Tamrazova A.V., Gryazeva N.V., Stenko A.G.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/3069

Целью исследования явилось изучение эффективности и переносимости применения фиксированной комбинации клиндамицина и БПО в различных клинических ситуациях в реальной практике. Под нашим наблюдением находилось 32 пациента с акне легко-средней и тяжелой степени тяжести папуло-пустулезного акне. Среди них 21 (65,6 %) пациент женского пола и 11 (34,4 %) пациентов мужского пола. Пациенты были распределены на две группы: первая группа (подростковое акне) – 17 человек, вторая группа (акне взрослых) – 15 человек. Алгоритм терапии включал применение фиксированной комбинации клиндамицина и БПО (Зеркалин Интенсив) на протяжении 4–5 недель с последующим переходом на использование топического средства с адапаленом на протяжении 6 месяцев. Всем пациентам была назначена специализированная дерматокосметика на постоянной основе. В результате терапии уже через неделю отмечалась достоверно значимая динамика в отношении всех клинических симптомов акне. Так, ВАШ (комедоны) в концу терапии снизился на 88,9 % (р < 0,01) и на 90,5 % (р < 0,01) в первой и второй группах соответственно. Аналогичная динамика отмечалась и в отношении воспалительных элементов (папулы, пустулы). ВАШ (папулы) в первой и второй группах снизился на 85,4 % (р < 0,01) и на 88,1 % (р < 0,01), ВАШ (пустулы) – на 100 %. Таким образом, применение фиксированной комбинации клиндамицина и БПО вызывает высокий терапевтический эффект в отношении всех клинических симптомов акне и хорошо переносится пациентами.

The aim of the study was to study the efficacy and tolerability of the sequential use of the fixed combination of clindamycin + BPO in various clinical situations in real practice. Under our supervision there were 32 patients with mild-to-moderate and severe acne of papulo-pustular acne. Among them, 21 (65.6 %) female patients and 11 (34.4 %) male patients. The patients were divided into two groups: group 1 (teenage acne) of 17 people, group 2 (adult acne) of 15 people. The therapy algorithm included the use of a fixed combination of clindamycin + BPO (Zerkalin Intensive) for 4–5 weeks with a sequential transition to the use of a topical agent with adapalene for 6 months. All patients were prescribed specialized dermatocosmetics on an ongoing basis. As a result of therapy, after a week, there was a significantly significant change in all clinical symptoms of acne. So VAS (comedones) at the end of therapy decreased by 88.9 % (p < 0.01) and by 90.5 % (p < 0.01) in groups 1 and 2, respectively. Similar dynamics was noted in relation to inflammatory elements (papules, pustules). VAS (papules) in groups 1 and 2 decreased by 85.4 % (p < 0.01) and by 88.1 % (p < 0.01), VAS (pustules) – by 100 %. Thus, the use of a fixed combination of clindamycin + BPO causes a high therapeutic effect in relation to all clinical symptoms of acne.

акнефиксированная комбинация клиндамицина и бензоила пероксидаЗеркалин Интенсивадапаленэффективностьбезопасностьacnefixed combination of clindamycin and benzoyl peroxideZerkalin IntensiveadapaleneefficacysafetyReferencesTan JK, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015; 172 Suppl 1: 3–12. DOI: 10.1111/bjd.13462.Tan JK, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015; 172 Suppl 1: 3–12. DOI: 10.1111/bjd.13462.Schäfer T, Nienhaus A, Vieluf D, Berger J, Ring J. Epidemiology of acne in the general population: The risk of smoking. Br J Dermatol. 2001; 145 (1): 100–104. DOI: 10.1046/j.1365– 2133.2001.04290.xSchäfer T, Nienhaus A, Vieluf D, Berger J, Ring J. Epidemiology of acne in the general population: The risk of smoking. Br J Dermatol. 2001; 145 (1): 100–104. DOI: 10.1046/j.1365– 2133.2001.04290.xКруглова Л. С., Талыбова А. М., Грязева Н. В. Эффективность применения системного препарата на основе изотретиноина при различной степени тяжести акне. РМЖ. Медицинское обозрение. 2018. № 4. С. 53–56.Kruglova L. S., Talybova A. M., Gryazeva N. V. The effectiveness of the use of a systemic drug based on isotretinoin for various severity of acne. RMJ. Medical review. 2018. No. 4. P. 53–56.Mayslich C, Grange PA, Dupin N. Cutibacterium acnes as an Opportunistic Pathogen: An Update of Its Virulence-Associated Factors. Microorganisms. 2021; 9 (2): 303. Published 2021 Feb 2. DOI: 10.3390/microorganisms9020303.Mayslich C, Grange PA, Dupin N. Cutibacterium acnes as an Opportunistic Pathogen: An Update of Its Virulence-Associated Factors. Microorganisms. 2021; 9 (2): 303. Published 2021 Feb 2. DOI: 10.3390/microorganisms9020303.Hwang HJ, Kim JE, Lee KW. Sulforaphene Attenuates Cutibacterium Acnes-Induced Inflammation. J Microbiol Biotechnol. 2022; 32 (11): 1390–1395. DOI: 10.4014/jmb.2209.09051.Hwang HJ, Kim JE, Lee KW. Sulforaphene Attenuates Cutibacterium Acnes-Induced Inflammation. J Microbiol Biotechnol. 2022; 32 (11): 1390–1395. DOI: 10.4014/jmb.2209.09051.Dréno B, Dagnelie MA, Khammari A, Corvec S. The Skin Microbiome: A New Actor in Inflammatory Acne. Am J Clin Dermatol. 2020; 21 (Suppl 1): 18–24. DOI: 10.1007/s40257–020–00531–1.Dréno B, Dagnelie MA, Khammari A, Corvec S. The Skin Microbiome: A New Actor in Inflammatory Acne. Am J Clin Dermatol. 2020; 21 (Suppl 1): 18–24. DOI: 10.1007/s40257–020–00531–1.Hazarika N. Acne vulgaris: new evidence in pathogenesis and future modalities of treatment. J Dermatolog Treat. 2021; 32 (3): 277–285. DOI: 10.1080/09546634.2019.1654075.Hazarika N. Acne vulgaris: new evidence in pathogenesis and future modalities of treatment. J Dermatolog Treat. 2021; 32 (3): 277–285. DOI: 10.1080/09546634.2019.1654075.Rosen J, Friedman AJ. Inflammatory acne: new developments in pathogenesis and treatment. Cutis. 2014; 94 (6): 266–267.Rosen J, Friedman AJ. Inflammatory acne: new developments in pathogenesis and treatment. Cutis. 2014; 94 (6): 266–267.Клинические рекомендации: Акне вульгарные. Российское общество дерматовенерологов и косметологов. 2020. 33 с.Clinical recommendations: Acne vulgaris. Russian Society of Dermatovenerologists and Cosmetologists. 2020. 33 p.Mohsin N, Hernandez LE, Martin MR, Does AV, Nouri K. Acne treatment review and future perspectives. Dermatol Ther. 2022; 35 (9): e15719. DOI: 10.1111/dth.15719.Mohsin N, Hernandez LE, Martin MR, Does AV, Nouri K. Acne treatment review and future perspectives. Dermatol Ther. 2022; 35 (9): e15719. DOI: 10.1111/dth.15719.Круглова Л. С., Самушия М. А., Талыбова А. М. Психические расстройства, социальная дезадаптация и качество жизни пациентов с акне и симптомами постакне. Журнал неврологии и психиатрии. 2018. № 12. С. 14–20.Kruglova L. S., Samushiya M. A., Talybova A. M. Mental disorders, social maladaptation and quality of life in patients with acne and post-acne symptoms. Journal of Neurology and Psychiatry. 2018. No. 12. P. 14–20.Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: How to manage acne vulgaris. Drugs Context. 2021; 10: 2021–8–6. Published 2021 Oct 11. DOI: 10.7573/dic.2021–8–6.Leung AK, Barankin B, Lam JM, Leong KF, Hon KL. Dermatology: How to manage acne vulgaris. Drugs Context. 2021; 10: 2021–8–6. Published 2021 Oct 11. DOI: 10.7573/dic.2021–8–6.Li ZJ, Choi DK, Sohn KC, et al. Propionibacterium acnes activates the NLRP3 inflammasome in human sebocytes. J Invest Dermatol. 2014; 134 (11): 2747–2756. DOI: 10.1038/jid.2014.221.Li ZJ, Choi DK, Sohn KC, et al. Propionibacterium acnes activates the NLRP3 inflammasome in human sebocytes. J Invest Dermatol. 2014; 134 (11): 2747–2756. DOI: 10.1038/jid.2014.221.Kim J, Ochoa MT, Krutzik SR, et al. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. J Immunol. 2002; 169 (3): 1535–1541. DOI: 10.4049/jimmunol.169.3.1535.Kim J, Ochoa MT, Krutzik SR, et al. Activation of toll-like receptor 2 in acne triggers inflammatory cytokine responses. J Immunol. 2002; 169 (3): 1535–1541. DOI: 10.4049/jimmunol.169.3.1535.Круглова Л. С., Грязева Н. В., Тамразова А. В. Состав микробиоты кожи у детей и его влияние на патогенез акне. Вопросы современной педиатрии. 2021. Том 20. № 5. С. 430–435.Kruglova L. S., Gryazeva N. V., Tamrazova A. V. The composition of the skin microbiota in children and its influence on the pathogenesis of acne. Questions of modern pediatrics. 2021. Volume 20. No. 5. P. 430–435.Cong TX, Hao D, Wen X, Li XH, He G, Jiang X. From pathogenesis of acne vulgaris to anti-acne agents. Arch Dermatol Res. 2019; 311 (5): 337–349. DOI: 10.1007/s00403–019–01908-x.Cong TX, Hao D, Wen X, Li XH, He G, Jiang X. From pathogenesis of acne vulgaris to anti-acne agents. Arch Dermatol Res. 2019; 311 (5): 337–349. DOI: 10.1007/s00403–019–01908-x.Sagransky M, Yentzer BA, Feldman SR. Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris. Expert Opin Pharmacother. 2009; 10 (15): 2555–2562. DOI: 10.1517/14656560903277228.Sagransky M, Yentzer BA, Feldman SR. Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris. Expert Opin Pharmacother. 2009; 10 (15): 2555–2562. DOI: 10.1517/14656560903277228.Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016; 74 (5): 945–973. e33. DOI: 10.1016/j.jaad.2015.12.037.Zaenglein AL, Pathy AL, Schlosser BJ, Alikhan A, Baldwin HE, Berson DS, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016; 74 (5): 945–973. e33. DOI: 10.1016/j.jaad.2015.12.037.Matin T, Goodman MB. Benzoyl Peroxide. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 10, 2022.Matin T, Goodman MB. Benzoyl Peroxide. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 10, 2022.Mohd Nor NH, Aziz Z. A systematic review of benzoyl peroxide for acne vulgaris. J Dermatolog Treat. 2013; 24: 377–386.Mohd Nor NH, Aziz Z. A systematic review of benzoyl peroxide for acne vulgaris. J Dermatolog Treat. 2013; 24: 377–386.Sagransky M, Yentzer BA, Feldman SR. Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris. Expert Opin Pharmacother. 2009; 10 (15): 2555–2562. DOI: 10.1517/14656560903277228.Sagransky M, Yentzer BA, Feldman SR. Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris. Expert Opin Pharmacother. 2009; 10 (15): 2555–2562. DOI: 10.1517/14656560903277228.Hegemann L, Toso SM, Kitay K, Webster GF. Anti-inflammatory actions of benzoyl peroxide: Effects on the generation of reactive oxygen species by leucocytes and the activity of protein kinase C and calmodulin. Br J Dermatol. 1994; 130: 569–575.Hegemann L, Toso SM, Kitay K, Webster GF. Anti-inflammatory actions of benzoyl peroxide: Effects on the generation of reactive oxygen species by leucocytes and the activity of protein kinase C and calmodulin. Br J Dermatol. 1994; 130: 569–575.Bandyopadhyay D. Topical Antibacterials in Dermatology. Indian J Dermatol. 2021; 66 (2): 117–125. DOI: 10.4103/ijd.IJD_99_18.Bandyopadhyay D. Topical Antibacterials in Dermatology. Indian J Dermatol. 2021; 66 (2): 117–125. DOI: 10.4103/ijd.IJD_99_18.Murphy PB, Bistas KG, Le JK. Clindamycin. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 27, 2022.Murphy PB, Bistas KG, Le JK. Clindamycin. In: StatPearls. Treasure Island (FL): StatPearls Publishing; June 27, 2022.Lomholt HB, Kilian M. Clonality and anatomic distribution on the skin of antibiotic resistant and sensitive Propionibacterium acnes. Acta Derm Venereol. 2014; 94 (5): 534–538. DOI: 10.2340/00015555–1794.Lomholt HB, Kilian M. Clonality and anatomic distribution on the skin of antibiotic resistant and sensitive Propionibacterium acnes. Acta Derm Venereol. 2014; 94 (5): 534–538. DOI: 10.2340/00015555–1794.Cunliffe WJ, Holland KT, Bojar R, Levy SF. A randomized, double-blind comparison of a clindamycin phosphate/benzoyl peroxide gel formulation and a matching clindamycin gel with respect to microbiologic activity and clinical efficacy in the topical treatment of acne vulgaris. Clin Ther. 2002; 24 (7): 1117–1133. DOI: 10.1016/s0149–2918(02)80023–6.Cunliffe WJ, Holland KT, Bojar R, Levy SF. A randomized, double-blind comparison of a clindamycin phosphate/benzoyl peroxide gel formulation and a matching clindamycin gel with respect to microbiologic activity and clinical efficacy in the topical treatment of acne vulgaris. Clin Ther. 2002; 24 (7): 1117–1133. DOI: 10.1016/s0149–2918(02)80023–6.Nast A, Dréno B, Bettoli V, et al. European evidence-based (S 3) guideline for the treatment of acne – update 2016 – short version. J Eur Acad Dermatol Venereol. 2016; 30 (8): 1261–1268. DOI: 10.1111/jdv.13776.Nast A, Dréno B, Bettoli V, et al. European evidence-based (S 3) guideline for the treatment of acne – update 2016 – short version. J Eur Acad Dermatol Venereol. 2016; 30 (8): 1261–1268. DOI: 10.1111/jdv.13776.Marushchak O, Gagliotti M, Vekaria AS, Goldenberg G. A Pilot Study of Clindamycin Phosphate 1.2 % and Benzoyl Peroxide 3.75 % Combination Gel in the Treatment of Perimenstrual Acne. J Clin Aesthet Dermatol. 2022; 15 (11): 18–21.Marushchak O, Gagliotti M, Vekaria AS, Goldenberg G. A Pilot Study of Clindamycin Phosphate 1.2 % and Benzoyl Peroxide 3.75 % Combination Gel in the Treatment of Perimenstrual Acne. J Clin Aesthet Dermatol. 2022; 15 (11): 18–21.Eady EA, Farmery MR, Ross JI, Cove JH, Cunliffe WJ. Effects of benzoyl peroxide and erythromycin alone and in combination against antibiotic-sensitive and -resistant skin bacteria from acne patients. Br J Dermatol. 1994; 131: 331–336.Eady EA, Farmery MR, Ross JI, Cove JH, Cunliffe WJ. Effects of benzoyl peroxide and erythromycin alone and in combination against antibiotic-sensitive and -resistant skin bacteria from acne patients. Br J Dermatol. 1994; 131: 331–336.Lookingbill DP, Chalker DK, Lindholm JS, et al. Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind investigations. J Am Acad Dermatol. 1997; 37: 590–595.Lookingbill DP, Chalker DK, Lindholm JS, et al. Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind investigations. J Am Acad Dermatol. 1997; 37: 590–595.Zouboulis C. C., Fischer T. C., Wohlrab J., Barnard J., & Alió A. B. (2009). Study of the efficacy, tolerability, and safety of 2 fixed-dose combination gels in the management of acne vulgaris. Cutis, 84 (4), 223–229.Zouboulis C. C., Fischer T. C., Wohlrab J., Barnard J., & Alió A. B. (2009). Study of the efficacy, tolerability, and safety of 2 fixed-dose combination gels in the management of acne vulgaris. Cutis, 84 (4), 223–229.Seidler EM, Kimball AB. Meta-analysis of randomized controlled trials using 5 % benzoyl peroxide and clindamycin versus 2.5 % benzoyl peroxide and clindamycin topical treatments in acne. J Am Acad Dermatol. 2011; 65: e117–e119.Seidler EM, Kimball AB. Meta-analysis of randomized controlled trials using 5 % benzoyl peroxide and clindamycin versus 2.5 % benzoyl peroxide and clindamycin topical treatments in acne. J Am Acad Dermatol. 2011; 65: e117–e119.Акне и розацеа. Под редакцией Кругловой Л. С. ГЭОТАР-Медиа. 2021. 207 с.Acne and rosacea. Edited by Kruglova L. S. GEOTAR-Media. 2021. 207 p.Kong Y. L., & Tey H. L. (2013). Treatment of acne vulgaris during pregnancy and lactation. Drugs, 73 (8), 779–787. https: //doi.org/10.1007/s40265–013–0060–0.Kong Y. L., & Tey H. L. (2013). Treatment of acne vulgaris during pregnancy and lactation. Drugs, 73 (8), 779–787. https: //doi.org/10.1007/s40265–013–0060–0.

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