medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2026-3-72-79medalphabet-4953Research ArticleСтатьиРетиноидный дерматит и ретинизация: от структуры ретиноидов к профилю переносимости и тактике веденияRetinoid dermatitis and retinization: from retinoid structure to tolerability profile and management strategieshttps://orcid.org/0000-0002-3933-6922ВашкевичА. А.VashkevichA. A.

Вашкевич Арина Александровна, к.м.н., доцент, доцент кафедры дерматовенерологии

Санкт-Петербург 

Vashkevich Arina A., PhD Med Sci, associate professor at Dept of Dermatovenereology

Saint Petersburg 

aavashk@mail.ruhttps://orcid.org/0000-0003-4920-5288ОльховскаяК. Б.OlkhovskayaK. B.

Ольховская Кира Брониславовна, к.м.н., доцент, доцент кафедры дерматовенерологии и косметологи

Москва

Olkhovskaya Kira B., PhD Med Sci, associate professor at Dept of Dermatovenereology and Cosmetology

Moscow 

olhovskaya_kira@mail.ruФГБОУ ВО «Северо-Западный государственный медицинский университет имени И.И. Мечникова» Минздрава РоссииРоссияNorth-Western State Medical University named after I.I. MechnikovRussian FederationФГБУ ДПО «Центральная государственная медицинская академия» Управления делами Президента Российской ФедерацииРоссияCentral State Medical Academy of the Administrative Department of the President of the Russian FederationRussian Federation20261404202603Дерматология (1)7279Copyright © Вашкевич А.А., Ольховская К.Б., 20262026Вашкевич А.А., Ольховская К.Б.Vashkevich A.A., Olkhovskaya K.B.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/4953

Ретиноидный дерматит представляет собой предсказуемую, дозозависимую воспалительную реакцию раздражения кожи, возникающую преимущественно на начальных этапах терапии ретиноидами и способную существенно снижать приверженность пациентов лечению. Рост частоты применения ретиноидов и расширение показаний к их использованию в дерматологии и косметологии подчеркивают необходимость разработки стандартных, доказательно обоснованных подходов к профилактике, диагностике и коррекции ретиноид-индуцированного дерматита. В обзоре систематизированы современные данные о патогенезе ретиноидного дерматита с акцентом на RAR/RXR-опосредованную транскрипционную перестройку, нарушение эпидермального барьера с повышением трансэпидермальной потери воды (TEWL), воспалительную хемокиновую активацию и нейросенсорную сенситизацию, ассоциированную с активацией TRP-каналов. Отдельно рассмотрен феномен ретинизации как этап физиологической адаптации кожи к действию ретиноидов. Предложена клинико-практическая концепция, отражающая взаимосвязь химической структуры ретиноидов, их рецепторной селективности и профиля переносимости. Представлены факторы риска развития ретиноидного дерматита, подходы к дифференциальной диагностике с аллергическим контактным дерматитом и розацеа, а также алгоритмы профилактики и ведения пациентов в зависимости от степени тяжести клинических проявлений, ориентированные на сохранение терапевтической эффективности без неоправданного снижения переносимости терапии.

Retinoid dermatitis is a predictable, dose-dependent irritant inflammatory skin reaction that occurs predominantly during the early phase of retinoid therapy and may significantly reduce patient adherence. The increasing frequency of retinoid use and the expansion of indications in both dermatology and cosmetic practice underscore the need for unified approaches to the prevention, diagnosis, and management of retinoid-induced dermatitis. This review systematizes current data on the pathogenesis of retinoid dermatitis, with particular emphasis on RAR/RXRmediated transcriptional reprogramming, epidermal barrier dysfunction accompanied by increased transepidermal water loss (TEWL), inflammatory chemokine activation, and neurosensory sensitization involving transient receptor potential (TRP) channels. The phenomenon of retinization is discussed separately as a physiological adaptive phase of the cutaneous response to retinoid exposure. A clinical and practice-oriented concept is proposed linking the chemical structure of retinoids, receptor selectivity, and tolerability profiles. Risk factors for retinoid dermatitis, approaches to differential diagnosis with allergic contact dermatitis and rosacea, as well as prevention and severity-stratified management algorithms are presented, with a focus on maintaining therapeutic efficacy while minimizing adverse effects.

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