Acne vulgaris, BymbrapHBte yrpu, — xpoHuueckoe nlomMMopdHoe MybTHaKTopHoe sabomeBaHHe BOMOCA- SIX (POITNKYIOB H CATHBIX xene3. 3aGorenaHHe Mopa- xaer ooo 80% simi or 12 20 25 net H npHMepHO 30— 40% nau crapwe 25 ser. Tenuienuna “Bspoctenua” aT0r0 saGoenaHid B HacTosiliee BpeMa, ero sHaNHTeNBHOE BIMAHME Ha TICHXOSMOUMOHATBHY! Chepy, COUMaTEEBIT crarye M OOulecTBeHHYIo anarrraltiio GombHLIX O6yCnOB- JIMBAIOT AKTYANBMOCTS AHHOM MpoGHeMBL H HeOGXoaH- MOCTS paspa6OTKH HOBBIX SdxbeKTHBHBIX CpeCTB H CxeM nevenua (1, 2]. Muorouncaenmnte uccneoBaHMs MoKasMBAIOT COK- uutit MymsTudbaxTopHBiit Xapakrep naToreHesa aKHe 2-4] Tlo nocneaHum aaHHbm [2], nepporaianHEie Mop- donormieckwe HIMeHeHHA MpH akue cBASAHEI ¢ Hapymte- HHEM TIPOLIECCOB OPOTOBEHHA YeTbsA BOMOCHHOTO *osTH- Kyla H O6pa30nanHem MHKPOKOMeOHOB. BHICOKMIt ypo- Belib CeKPeUMM CANbHBIX Kees ¥ BSPOCTBIX — RAKHOE YCHOBHE UIA (POPMHPORAHHA AKHE Ht NACTO KoppemMpyeT ¢ TwKECTHIO saGoreBAHHS. YMCHbUIEHMe CHIITe3a KOXHOTO cana MpuBoauT K BILIMMOMY KIKHIYeCKOMy yarysNeHI. ViapectHo Tarke, 4T0 XHMHYeCKMIt COCTaR KOXHOTO casa 1M STHILePMANbHBIX JMIIOB GONBHBIX akHe OTAHYACTCA OT cocrasa ce6yma snopousix monet. Y raxwx mauleHTOE HaGmONaeTCR CHIEKEHHE COMepKAHI ANHONCHOBO! KHC- JOT, AULWTILEPAMHIOB H CBOGONMBIX Crepo0B. B pesy.b- Tate Hapylualorca mpouleccsl ecKBAMAMIN. STuMTeAMaTE- HBIX KIETOK (POITNKyZa, TO BENET K O6pasORAHMIO PeTeH- UMOHHOTO PHNepKepaTO3a AKPOBOPOHKH CaIbHBIX :OrLTH- xyzl0B. IIpHMevaresibHo, 470 cocraB ce6yMa ocTaeTes He- © Komextns asropos, 2003 WOMEHEHHBIM Jake MIpH YoTyNIMEHHIE KMMHIECKOHt KApTH- HBL Tlpoueccs: oporonennis » yerbe boLIUKyLIa KoHTpOALH- pylores ocoGEIM GenkOM — mpocbytarpuHom, cHETesHpy- eMBIM KIETKAMH UNMOBATOTO COR. B KETKAX 3epHHCTOTO clos stor Geox mpeodpasyerca B ¢>MIAIPHH. H HaKANLUA- BaeTos B KepaTorHaMMHOBENX rparytax. Y GonbHBIX aKHe onpenenserea u36srTo¥HOe HaKOTLAeHHe Mpodbw1arpuHa HK ¢warpuna, sro mpHBomHT K NoBSILNeHHOMY OporoneHtitio BHYTpH homtuxyza (2, 5—9] ‘TakiM obpasoM, B pesymbTaTe Hapyimerma ¢irsHo70- Tit¥ecKoit necKsaMaluit Ha oHe TIOBBILICHHOH CeKpenIMHt CcATbHBIX 2Kes1es COMAIOTER aHADpOGHEIE YCROBHE, KOTO- PHE ABASIOTCH ONTUMANSHEIMM JIA GsfeTpOTO pocra H pasMHoxcenus murxpoaspodiisstx Propionbacterium acnes (10). Tloxasavo, ¥r0 TombKO TpH IpynMTst MUKPOOPraHH3MOB ABAMOTCR MpWHMHOM PAsBUTMA BOCTIAMHTERbHOTO m1po- wecca B CAABHBIX 2eNe3aX: — P. acnes, — Staphylococcus epidermidis u apyrue KOK; — amodunsiste pox pora Pityrasporum (P. ovale 1 orbiculare). SIM MHKpoopranWsMst BeerHa MpHcyTeTBYIOT B KOMe- AOHAX, ABILICS YaCTHIO HOpMaTBHOH MHKPOXpTOpEI KOKI amu. S. epidermidis 4 apyrue KOKKK oGHapy:xUBALoTCs B ‘OcHOBHOM B BepXHeil YACTH BOPOHOK BOMOCAHELX (bowLI- KYAOB WIM B MECTaX OTKPEITHS MPOTOKOB NOTOBEX xeTe3 Wi He MTpaioT SHaNHMOH pomH B MaToreHese aKHe. Xora y GoubHBx akHe Yallle OGHAPYAHBAETeA KOMGH- Has upoxxertonoGHoH (P. ovale) M GaktepnambHolt (P. acnes) (bxopbi, B HACTOSTIICe BPeMs YCTAHOBTEHO, TO P. acnes BiAeTCH OCHOBHEIM HHeKUHOHHBIM areHTOM,rparoummM KiONeBy!O pons B Marorentese axHe. HeeMorpst HA TO YTO PAIOM ABTOPOB OFIBTHEIM TYTEM Ha H3ONHpO- BAHHX OIKYsIAX NoKAsaHO O6pasonaHMe OTNEMBHENX aKHe-osleMeHToR HB OTCYTCTRHE P. acnes, HCE Ke UMECTCH OcTaTONHO OKASATEMKCTA yuacTus P. acnes B Mponiecce opmnporaria axne (11, 12]. Mponykret xusteslestens— nocta P. acnes (qumaaut, mpoteasst H sIpyrHe 2H3"MBi) CTHMYTHpyIOT KoMeNOHOOGpax0BAHHe HM BBISBIBAIOT’ O- BpexneHHe PoMMIKYARPHOTO SMMTEMMA, NTO MPUBONUT K assuming BocramHTeNBHOH peaKunH B aepme [2, 13]. Aicxyrapyeres pom cnobomsxcxupubix neror (CK), oGpasyionuxe B Mpotecce opwmposarns pacuterie- HMI TPUEMAMEpHTOB ceSyma GaKTepHaNbHOH mTasoit [14]. Yacrs astopos nomaraot, w70 CKK, oKassipat BEIpaKeH- Hoe KomexoreHoe seficTBHe in vitro, cOCOGHE! NOBpex- aT (bomMKyaapHylo cTeHKY HSHYTPH, MPOBOWEpys BOC namrenbuyto peaxmio [15]. Tlo narets mpyrHx MecmeO- Bareveit, BHYTpHKOXHOE BReeHHe CKK He MPHBONHT K ‘obpasonaHiio BocnamMTenbHBIX snemeHTon. MpHMeHeHHe MUTHOHTOPA THTASKL, MPHBORAUETO K 3HANHTEMBHOMY YMCHBUTCHHIO YPOBHA KHDHBIX KHCTOT B ceGyMe, OKASa~ WOCh HesieKTHBHAIM B TIpodWlakTuke paseuTuA BOCTa- aremBHBrX azteMeHTOB [2] Tlo MHeHm0 HexoTopsix aBTopos, MHMIMAPYIOUIEM akTopoM BocriaieHus pH aKHe ABILAIOTCH UMTOKMHEI, MpowsboaHe KepaTHHOUnTOB, YKaSBIBAeTEA Ha BKICOKH ponent wiTepzetixiHa-1 Bo BCeX KOMeNOHaX. [IpoHMKHO- BeHWe wiTeprelixuna-1 B nepMy cnoco6HO BEIsEBATH pocramrensiylo peaxuyno B Heit [16]. HaTHTeMBHAN PON B MaToreHese akHe OTHONHTCA TOOBBIM cTepouNHBIM ropMortam (2, 13]. Koxxa yeoneKa ABIMICTCA KOMILTEKCOM aHIPOTeHIYBCTBHTENEHEIX CTPYK- Typ (CaMBHTBIe H OTOBHIE KeesBI, BONOCATEIe COsLTHKY- ag). Tlox RIMAHHeM artnporeHOD HaxONsTCH MHOTHE Baxk- HBC QYHKLMM KOXH: MITOTHMECKAR AXTHBHOCTE KTETOK, AKTHBHOCTS CABHBIX KEES, POCT BONOC, BEIPAKCHHOCTS nrMentauum. Tlepsle KIMHMYCCKMe TIPH3HAKM acne vulgaris nompnsotea B nyGeprarHom mepuore, Ha ore TuMIepaKTHBHOCTH OTOBEIX Xes1e3. HepenKo aKHe BOSHH- KaloT Y XeHLMH ¢ CMHAPOMOM runeparmporeHM, MPH AMIMTE:IBHOM TIPMEMe aHLAPOTeHOS TIPH PASTHMABIX SHUIOK- PHHHBIX saGonepaHHsX, TIpH MpHeMe anaGomMeckHx ropmonos [17]. B rumepcexpeimu camsitix xenes H MOsBIeHMH aKHe- SNeMEHTOB BAXHEIMH MPeNpACTIONATAIOUDIME ¢bakTOpAMHL ‘aBISNOTCs: — TOBKIUIeHHe ypoBHis TecrocTepoHa B KPOBH; — TOBKIINEHHAS SYBCTBHTENBHOCTS BOTOCATTEN ¢bon- SIMKYNOB H caNBHEIX 2Kene3 K aHAporeHaM; — coveranme oTHx axtopor. VispecTHo, ro 8 paSBHTMH THMepCeXpeniTH CasTBHBIX xkene3 yuacTByeT HanGonce aKTUBHBIH MeTaGOIHT TecTO- ctepona — Sa-nuranporectocrepox (JIT Il). Kpome toro, canbHam Kexesa TAKE cTlocoGHa MONeIHpoBATs cob- CTBeHHY!0 AHEpOTeHHYIO peaKUMlO, TAK KaK oTMeyaeTeH ASME BEUTeMEHMe KOXHOTO Calla Y JON ¢ OMHHAKO- BHIMM TIOKA3aTEARMH KOHCHTPAIHH TECTOCTEPOHA B CHI- BoporKe KpoBH. OcHoBHas wacTs (110 65%) TecrocrepoHa H Derpamwona ceasaHa c GenkoM — nomoBite crepowtst Consuiparouni rnoGynnn. Samm 5% monoBEIX cTepowTOB HAXOMHTCA B CHIBOPOTKE KPOBH B CBOGONHOM COCTOAHHH. Tonsxo 9TH cnoGonHo MUpKysupyIoUNE MoTOREIe TOPMO- HB SBIOTCH GHONOTHNECKH AKTHEHEIMM Ht cTOCOOHBE TPOHHKATS B KUCTKH-MMINCHH, BBISBIBAS B HUX OHOXHMI- 10 veckve orserit, [osromy KAMHYECKH CKpBITHIe (bOpMBL THMIepAHAPOTeHMH MOKHO OMPEAETHTD TOABKO M10 Pe3y.tb- ‘Taram HecHenOBaHHit CBOGOMAEX )pakUHH, a NOBBILICHHE KoHMeHTpantH Otero TecTOCTepoHa MaTOMHOpMaTHB- Ho [2, 13, 18]. HanGonee syscrautensimsmat 1 ZocToBep- ‘HBIMM MapKepaMM TMMlepaHAporeHHH ABIAeTCH pakuAA cBoBomHoTo TectocTepoxa B cEIBOPOTKe KpoBH. I'umepCeK- PeUUWA KOKHOTO CaslA ECTS CHEMCTBHE BRICOKOTO ypOBHs @HUPOFeHOB, a TAKKE TEHETHYECKH OOYCIOBIICHHOM BbICO- Koil SYBCTBHTEABHOCTH K HUM CAIbHBIX 2Ke1e3. OTy 4yB- CTBHTENBHOCTS OMpeneAMOT NPHCYTCTBYIOMIME B KNETKAX epmennt: 1B-, 3B-rumpoKcucreponmermaporenasa 1 Sa-peaykrasa. Tocnenuas nepesonur cpoGomMbii TecTo- crepon B JIT], Kotopstit smaserea HenocpencrBeHHnim CTHMysIATOPOM KOKHOTO cata. OTMeYeHO, ITO ¥ GOMBHBIX akHe Gvocuntes JT] s cambinix xesiesax Bhule B2—30 pas TIO CPaBHEHHO CO 3TOPOBKIMH SHONBMH. Vinorna nosinxaer Heo6xonMMocTS LOTIOAHHTS OGcre~ Rosalie GOMBHEIX aKHe OMpeneeHHeM ypoBHA anpeHto- KOPTHKOCTepoWoR, MporecTepoHa, CoMaTOTpOMHOTO Fop- MOH, TOPMOHOB rHnodu3a WM THMOTaTaMyca. 3aMeTHas pomb B MaToreHese aKHe HrpaeT TAKE Ha- cneqCTBEHHAR MPeMpAcHOXOKEHHOCTS ¢ TEHETHYECKH Ae- ‘TePMHHMPOBAHHBIM THTIOM CeKPCUMH CaTbHBIX e1e3. 970 onpenenseT B aanbHciem TeYeHMe naToTorHYecKorO Mpowtecca H BHpAXeHHOCTS KTMHHYECKHX MpomBIeHHit 119}. Vioraa teyenme akve Moryr yxyauiarb pase ‘9K30- H SHMOTeHHBIe (bakTopsr: MpoceccHoHAMbHBIE BET HOCTH, KOCMETHYECKHE cpencTsa, HIOBITONHAR HHCOTA- tna, Tporaeeckuit kumar W mip. Tem He MeHee OCHOBHOM POW B TlaroreHese aKHe OHK He HTpaior. Kaaccndukauua axne Ho Hactosmiero ppeMeH Her YeTKolt MExIyHapomHO! soracembukanicx axe. HanGoree nomHott manseTea KTaCcH- cbuxaums, mpeatoxernias G. Plewig, A. Kligman (1991) — MpH3HaHHBIMM aBTOpHTeTaMH 8 OGnacTH HayNeHMA aKxe. 1. Heouaransuue yrpa. 2, Maagemyeckne yrpu: — KOHTIO6aTHBIe YrpH MuIANEHIEB. — acne inversa; — acne fulminans, — Teepabiit nepencTHpyloutHit orek mHIa MpH aKHe; MexaHHveckue yTpH. 4, Yepm nspocansx: — ToKamw3onaHHBie Ha cTMHe; — Tponrieckne; — NocTiOBcHWNBHBIE YIpH y KeHLIMH; — nocrweHonaysanbibie; — cHmapom MackyamensauHM y XxeHLIHH; — MOMMKHCTOS sHHHAKOB; — aupomoreoma GepemeHisnx; — wo0BITOK aHIporeHOB y MyACHHLH; — XXY-accoummponannnie KoHrT0GarHBre; — nonmurossie; — TecTOCTepoHMHAYUMpOBAHHNIe MOsIHMEHOCHEIe YrpH Y SPeSBbIVaHIHO BBICOKHX NOAPOCTKOB MYXCKOTO 10a. 5. Kowraxrusie yrpx: 1, 2003— Koomer#ueckne; — acne vulgaris wa nomany; — xmopakne; — KupHBe H CMomAHBIe yrpH. 6, Komenonamsune yrpu sctencrane Boazelicrsna dn- swsecKux qraxropos: — emmmniranste KoMenoHBt (Gonesi Daspa—Paxyuto); — COMAPHBIE KOMEHOHBI; — MaliopKa aKue; — acne vulgaris » pesynstare wounsypyiomet panua- UHH. Pasmualor cHenyioune KIMHMYeCKHe (opMbI akHe: 1, Hepocnanutenbupie axte: — KOMeTOHS! OTKDHITBIC, SAKPEITBIC; — MiTHyse. 2. Bocnanurensinie axe: — TosepxHocrimie marymst, MycTymBr; — ryGoKHe HayparHeHBte, KOHTTOGATHEIe; — ocnoxnennste abcueaNpyioumte, duerMoHosHBte, MONHHEHOCHEIC, AKHE-KENOWL, CHHYCOBKIE akHe, py6Uy- roummeca akne. B 1978 r. G. Plewig, A. Kligman [2] npemtoxwm OlleHHBATS THKECTS 3aGONERAHMA Ha OCHOBAHHH MOMCYeTA BHICLINAHHH Ha OAHOM Cropone JHA H KaccHHLMpo- barb €€ NO rpalaulMM H CTeeHH TsEKeCTH. Tpananna I — KonmyectBo KoMenoHOB MeHee 10. Tpananna TI — Kosmecro KomenoHos or 10 10 25. Tpanauua IIT — xonsyecrso Komexonon or 26 110 50. Tpananus IV — Komriectso Komexonon Goree 50. Crentens I — kommuecrso ranyro-mrycrya Mexee 10. Crenexs If — xoamuecrso nanyzio-nyctyst oF 10 10 20. Crenens II — komruectso nanysio-nyctya or 21 70 30. Crenens IV — xommuecrso nanyno-nyctya Gone 30. Kawanxa Kanunieckas Kapruna npu acne vulgaris xapaxrep- syetea OAMMOpdusMoM BiIChIMaHKA. Ha Koxe sua TYOBMULA ONpeessOTCH KAK HeBOCHUIMTEJISHBIE AKHE- SNeMeHTHL, MaMa, MYCTYAbI H MIp., TAK M BTOPHYHBIE HOCTSPYNTHBHBIE UCKPOMHH H pyGubi. 3aGoreRaHHe OOH HaYMHAeTCs B MyGepraTHOM mepHoue H XapaK- TepHsyeTca MOABIeHMeM Ha AMMe, peke — Ha TpyaM, OMHHE KOMeTOHOR, MenKHX 110 5 MM B AHaMeTpe Tanya ApKo-KpacHoro useta uw nyctya. Komenoun opMmupy- ores B pesysbTaTe THMepceKpeMLUH KOKHOTO cata M pereHUMOHHOTO TumepKepatosa. [peacrasamoT coGoit MIoTHOe OGpasoBaHite, CocTOAuMee 3 ce6yMa, Goxb- uioro KOAHYeCTBA KOpHeOUMTOB, MUKpOOpraHUsMos (P. acnes 10°", S. epiderm, P. ovale). Ormenaetca TecHas CBASh MEXAY AKPOHHYHANGYIIOMOM 1 OGACTEIO TIOp. Tipu runepkepatose akponHdytu6yioma BBIBOAHOe OTHEPCTHe CTAMOBHTCS PACIINPeHHBIM, H HepBEIMH BH- AMMBIMH BBICBIMAHWIMH GYIYT OTKPBITHIE KOMeOHBI (33, 34]. BusyanbHo onm BuIFAaAAT KAK YepHBte TOOBKH auaMeTpoM I—3 sent. ITpa rHnepkepatose mudhpanndhyst— MUGYMOMA BHIBOTHOe OTBEPCTHe He pactIMpseTes, TO- cTeMeHHo Kanan 3anoaisteTCs AeTPHTOM Ht Cato. TaKHM O6pasom, ‘OpMMpyIoTCs JaKPEITHIe KOMEHOHBI, KOTO- Dhle BRITA KAK METKHE ManysesHble SneMeHTsI Tene- cHOTO BeTa 10 2—3 Mat B AMaMeTpe. Hepesko dopmut- pyloTCs BOcTIaMMTembHbte IneMeHTEI: MenKHe 110 3—5 MM B AMaMeTpe Tanyabl M NYCTYAB pKO-KpacHoro uBeTa. BIchINaHHs, paspeulasch, OCTAmIAIOT MFMeHTaIUMO, pexe — nowepxHocrapie pyOunKH. 1, 2003 SS naroreve3 gffAtiinn acne CanoomeneHne y TaKHX naliMeHTOB TloBLIeHO, KOKA MMeeT XapakTepHbt XHPHBI OnecK, BoNOcH TAKE KHP- HbIe, BOSMOAHO HesHauMTebHOE CeGopeltHoe NopeTeHHe. Or panel cranuit HenocriamTesbHbix KOMeIOHAT- HBIX akHe, 3a KoTopoit cremyeT MomBTeHMe HeGoULIOrO ‘MUCHA ROCTIATHTEMBHBIX Su1eMeHTOB Ha JTHHe, 3a607eBaHHE oGer4Ho mporpeccupyer K Goce TeHepamH30BAHHBIM (POp- Mam. KomiiecTso KOMEOHOB yBemUMHBACTCH, YCTbA (Or- JTAKY08 pacuuupaiores W 3HstOT, KOMeOHBI BOSHMKaIOT He TOKO Ha JIMLe, CHMMe M rpyaH, HO MB 3ayUNHBIX oGnacrax, Ha BonOCHcTOit sacTH ro7oBE. BocramrenbHas eAKUMA BOKPYT KOMCOHOB, MaNlys0-NYCTYA CTAHOBHTCA Goulee BkIpakeHHoll, (bopMUpyIoTCA KpyMHBIe EyGoKoTe- oxauime BocrasmTerbHEIe Yanbt. Tak BOSHUKAIOT HHLIYpa- ‘THBHBIE aKHe. ‘Yepes HecKoABKo Heme HHdWITpAT pasmaruaeToR, YanlbI BCKPHIBAIOTCA ¢ OBPAIOBAHHEM NOMOCTH, H3 KOTO- poit Biimentetca Tarysutt THoltHBI oKccynaT (hierMo- WOSHBIe akHe). Tlocae 3akMBNEHHA OcTaloTeA TYGOKHE obes06paxnEaiounte Koxy pyGum. PacripocrpaHeHHocTs creme THKECTH aKHe, KaK MpaByno, KoppeampyeT ¢ BHIPAKCHHOCTIO pyGueoGpasosaHHs. A. Layton (1994) moxasail, 40 y 85% GombHbIX Kenomuuble pyOUb! pasBH- JMCb TPM MEIYpATHBHBK M HOAYMOKHCTOSHEIX qopMax akHe # Tonbko y 15% mauMeHTOs — mp nanyzesHo- YCTYNESHEIX BHICHITIAHMAN. Camoit pacnpocrparennolt dopmofi ¢ sbipaxenHbim BOCTIATHTEABHEIM KOMIOHEHTOM sBIHOTER KOHTIOGar- iste yrpi. KinHitveckast KapTiHa XapakTepHsyeTem MOsB- JleHMeM Ha CHiHe, TpYAH H AIHLUe KPYTIHBIX y310B, pacrio- BATAIOUTHXCA TIYGOKO B JAepMe, MHOTAA 3aXBATHIBANOLLHX BEPXHHE OTENST MOAKOXHOM kUpOBOMt KIeTHATKH. YanbL Moryr aocrurars 1,5—2 cm 8 anamerpe. Takne yah KpaitHie GonesHeHHBr, OCTpO BBIpakeHO MepHboKambHoe BOCTANe- ume. Crmpasich, yaiibt O6pasyloT KoHTTOMepaTsl, MoryT BOSHUKATS AGCUECCEI, NOCITE BCKPLITHS KOTOPHIX OCTAIOTCA IDIATENbHO HESMXMBAIOIIME ASBBL, a BOCIeACTBMM — rpyGbie pyGust ¢ TlepeMBIuKaMM CBHILEBBIM XonaMH. Hnoraa rayGoxo pacnoxoxenttble BOCTIaeHHBIe ya campaiores 1 O6paz} ior STMMTesIMAAIBHIe CHHYCOBLIE TPaK- ‘Tol, Kak Gor “TlonpBIBAIOMINe” KOKY HUA H TyAOBMULa, — cHHyconbie akHe. Onnun 43 peaKHx BapHalToB BOCATHTENbHDIX aKHe, Mp KOTOPOM MpowCKXOMHT TpaHccopManus THNMYHEX BOCHATHTETBHBIX AKHE B KpatiHe BHIPAKEHHOE eCTpyK- THBHOE BOCTIATeHMe, ABAMOTCH MOMHVCHOCHBIE aKHE (acne fulminans). B OCHOBHOM CTpanaioT MomOMBIe MYAYMHBI. Tlosaimiorea MHOXecTBCHHBIe OoNlesHeHHBIe HEa3BIaI0- MECH C YYACTKOM HKPO3A BOCKIA/ITEABHBIE Yat, Pac- CemHHEte TYCTY.B, pacrlomaraioulMecs Ha 9pHTeMaTO3HOM. houe. TMpouecc conposoxuaerea snxopaakoit, seitxoun- ‘TO30M, GOAMH B CYCTaBAX, TPAHSHTOPHBIM TIOMEPYTO- He@pHToM. 3axnBreHHe MpoHicxoAMT ¢ o6pasoBaHHem mpy6tmx py6uoR. Tlocrarownio penko Berpevaerea rmonepMaA Hua — ocTpoRocnamrenbHaa Mi THKeNO NpoTeKaloniad ¢opma axxe. Tvonepmnett mma vane crpanaiot Moonbie 2KeH- ILMHBI, MepertecuIMe SMOUMORATBHBI cTpece HAM pare TONYYaBIIHe AHLApOTeHBI TO NOBO:Y IHAOKPHHHBIX 3a60- sresaniit. Jlepmatos xapaxrepusyeTcs BHe3amHbIM Haya- OM OBICTPSIM MpOrpecempoBannie. Y wcex Gomsanix mpoulece JoKaTMsyeTet B UeHTpaIbHOMt YacTH JMUA, B oGnacra 16a, BHcKOB, moxGoponka. Tlosmuserca BuIpa- 2XKeHHBIH OTEK C UMAHOTHYHBIM OTTEHKOM KOXH, 3arem 1— uOB30P AVitebATYPLI 2.qua chycta BosHMKaloT KPyIBIe (Goutee 5 Mat) MyCTYsIB, GonesHeHHsie GypyHKysonosobuste yanoBaTBIe BEICBITa~ HUH, HarnloMuHatouIne TakcKe KOHTIOGaTHsIe akHe. OTMe- MAIOTCR OTCYTCTRKE KOMEOKOB M Pe3KAR BHPAKCHHOCTS TpaHMN, BocaneHMa. Bropyinie moctaocriammrembiBe W3MeHeHHA KOXW TIpH AKHe: PACLIMPeHHBIe sHsIOMUHe Topsl, THneprurMeHTaLMH, AMCXpOMHH, pyOUB — ABs JoTea XApakTepHBIMMK KIMHHYECKHMI CHMITTOMAMH, T- TOTHOMOHINETEIN MpHaHaKaMM acne vulgaris HapaTy © KOMCsIOHAMH H BOCTIAIIMTENbHBIMH 31eMeHTAMM, Jlesenne BuGop TakrHkH AeveHus onpedesieTes HaToreHeri- YecKHMH (akTOpaMH, KIKHHYeCKO!i opMoit saGonena- HU, THEKECTHIO H MPOLOMAMTEMBHOCTHIO TEYEHHA, HAH NHEM COnYTCTAYIOULe! SHTOKPHHHOM UM CoMATHYeCKOit naroxorui. Bosbiioe sHaveHHe HMeeT OlleHKa TICHXOIMO- UMoHaMsHOH cepsi, CoMMaTEHOTO cTatyca, OOulecTBeH- voit anarrraunm GosbHoro. Tipaswibas OlleHKa THOKECTH KIMHHYECKHX MposETe- ul nosBomseT onlpeemuTs TakTHKy sleveHMs. CyulecrByeT MHOXECTRO METOJIK OUCHKH THKECTH aKHe, ONHAKO B Gomsmmmcrse cryYaes LOcTATONHO pagmenleMe Ha TPH creneni: sterKyio, cpeamnow a TwxKesTyIO. MpH serKoii CTeNeHH THKECTH B KIMENYECKOHL KapTHHE MpeoGuaAaOT KoMenoHsI H He Gone 10 nanyzo-nyerya, upH cpemuedt ‘DOKECTH aKHe KOAMYECTBO MaMysIO-NYCTYT He TpeBBIULAeT 40, eqMHWUHBIe MHALYPATHBHBIE S1eMeHTHI, BO3MOKHO HAIHUHe TOBepXHOCTHBIX pyOuHkos. TIpu akHe Takeo! crelleHit manyaesHo-nycrymesHbXx sneMeHTOB Gonee 40, MHoxecTBeHHB(e THTepTHTMeHTaLHK, pyOust. [pH Homy- JIOKHCTOSHOH (POpMe akHe CrenteHb THKECTH OMIpeeNAETCs Kak CpenHAs 1 Tkemas. ‘Tas nevenus axe mpunersierest cHcTeMHaN H HapyK- vast Tepams. Cuctemmaa Tepanus Cucremias Tepannia HasHavaeres sia neyenna Gomb- MBIX CO CPemHETAKeTOM HH THKEIOM CopManit aKHe, ocobeHHO B cmyyae OOpasoRAHNs pyOHOR, a TAKKE Ip BHIpAXeHHOTl seNpeccuH, AMcMOPKbooGHH Ha (oH ser KOTO TeveHHs aKHe, MpH OTcyTCTaHM axbibeKTa OT Hapyx- Holt Tepammm no ucTeveHuH 3 Mec eveHHA. Cucmennas mepanun axne c yeabio nodasrenua eunep- naasuu cansnoti aweneadi w ceBopeu K oncremsme mpenaparant, yMerbitiaiommm o6pas0- BaHHe calla, OTHOCHTCA: = waorpermHonn; — anruanaporenbi; — serporent; = cnmputonaxtox. Ha nactosmiee spema casi ohpexTHBHBIM Mpertapa- ‘TOM ALA NeYCHHA TXKEBIK (POPM AKHE sIBAETCR HSOTPETH- non, Hsorperanors (poakkyran) — emmcrserutit mpe- apat, BTAOUN Ha BCE TaTOTeHeTHMeCKHHe 3BEHBA 3a60- srepannia. Cyrouriaa s103a cocrasnset 0,5—1,0 mr Ha 1 Kr Macebi Tela, He Nowa npesbinuaTs 60—80 Mr B cyTKiE Vorperitons oxa3bisaeT BIMAHMe Ha mposmepaunno 1 auibdepesimsposky ceOonMTo, pesyyTsTaTOM Vero sBILICT- CH BHIPAKEHHOC YMEHBIEHMe PASMePOB CATBHBIX KeIIes H mporyxuumt KoxHorO cata. TIpenapar yMeHBuaer (bopMit- POBAHHE KOMCOHOB B pesymbraTe HopMamusaunn MAdde- PeHUMPOBKH KNeTOK SMMTETHA CTEHKH M YCTbA BOROCHHOTO coamnxyna. Kpome Toro, Ha0TpeTMHOMH slaeT OOuEHE TIPO- 12 ‘THBOBOCKAAMTeNbHBI odipeKT 3a cueT peryaupyioulero BIDTHHA Ha rIpoueccit XeMoraKcHca H (baroumTosa. [IpHMe- HeHMe WSOTPeTHHOHA orpaHieHO eTO TepaToreHHBIM ARHICTBHEM HK TAKMMH TOOBIN SeebexTaMM, KaK xefLNT (96%), cyxocr KoxtHEK HOKpoBOB (20—50%), apTpANTH Muarni (1S—35%), nosbiuenHe COS (33-40%), muna Be Hapyuienua (15-25%), BosMOXHBI empeccHBHBIe coctosHi, Tunepoctosst. Boe 970 BiI3biBaeT HeOXOmH- MOCTS OCTOPOXHOTO MPUMCHEHHS WoTpETHHOHHA, O6A3a- ‘TesIeH KOHTpomTs NeveHOMNEIK npOG 1 pas B 4 Hen [2, 20, 21] oKennnmnant penporykTHBHOrO BospacTa ¢ CHHAPOMOM MACKYTHHHSAIHH W/IUIH C TIOTHKHCTOSOM SHTHHKOB TIpHt Ham FOPMOHAIIHLIX HapylleHHit H TIpH HeadbexTHs- HOCTH OGEIMHOH TepanHH NOKasaHO MPHMeHEHMe aHTHaH- aporenos. Lunporepora auerar, Groxupyiouutit peuierrropit aH- APOTEHOB B OPTaHAX-MHIMICHAX, MOSBOMHET YMCHEUIHTS ABICHMA AHMPOreHMSAUH y OKEHILMH, B TOM YHCAE H ceGopen, npenynpenHr. o6pasopale HOBKIX aKHe-D:1e- Mentos [22]. Bercoxas z03a imporepora arrerara (50 Mr) conepxutca B nperiapate aHuapoKyp, KoTOpsIit HasHavaIoT ¢ 5-ro no 14-ft zen menctpyanbiioro uvKna. Auane-35 TipeaicramaseT co6oit KOMOMHHpOBAHHBIi KOHTpalleTTHB- nuit npenapar, cocrosmusti u3 2 Mr umpotepora auleraTa a 35 Mr STHMMUISCTpamMONa, Hapsy c aHTHaHApoTeHHBIM AeHCTBHEM OKASbIBACT BHIPAKEHHOE TecTAreHHOe H AHTH Toxarorpontioe meficrsxe [23, 24]. Crmpuonaxtox 6 03¢ 100—200 mr/cyr naer nocta- ‘TouHBI ceGocynpeccumubtit sddbexr M yaystaer coctos- He aKHe 3a CyeT H3OupaTeMbHOTO TlowaBIeHMA bepMeH- Tos B HannovewKax (17a-, 11B-, 21P-rampoKcuas). Manbre oabr (25—30 ser/eyt) odxbextHaet Bpyt eseHHtH nonepXHOCTHBIx (POPM aKHe M peMeHCTpYALBHBIX aKHe. Tepannis MponomHTes ATHTETSHO B TEYEHHe HECKONBKHK Mecsiues. Ip npHeMe CiiMpHHOMAKTOHA MOLY? BOSHHKATS -Hapyliera MexierpyamsHoro 1nski7a, runiepkamtuents. KpoMe TOTO, MMEIOTCH HAGMOTEHUS 0 MOBBIINEHHOM PHCKE BOI- HUKHOBCHNA OnYXONei MoTOYHOH >%eNe3b1 [25} Tepopaitbiisie KOHTpallenTHBbI CHIDKAIOT YPOBeitb aH AporeHow 3a cyeT CTHMYSIIHH cHHTeSA TTOGyTHA, CBA- SetBalOlleTo CROGONHEI TECTOCTEPOH, M MoNaRICHIS CeK- eum ronazorponvina. AKTHBHbIit Scrpore — oTHHHLI- SCTPAAHON CONEPAMTCS BO BCEX MPUMEHSEMBN B HACTOS- lee BPeMA OpAHBIX KOHTPALETITHBAX. TopMonatbiie nperiaparst HasHayaiores -KexmuMHaM Tip cpenveraxeroit u Taxenolt (opmax aKHe Tocse KONCYITANAM THHEKOMOTA-HIOKPHHOOrA C TOCIeNYI0- HM HaGmonennem (24, 26]. ‘Cucmemnaa mepanua axne ¢ yes nodasaeHua Muxpo6- Holt Kononusayuu oaauKyaa AuTuGakrepHaibubie Mpenaparsi, MOMMMO npaMoro GaxrepuocrarHyeckoro aelicrans, maioT Hecnenmdrec- Kuti npotHBonocnarutenbHbiit sdybext. Tax, oKcnepH- MEHTATBHO MOKASAHO, “TO AHTHOAKTepHANbHbIe Mpertapa- ‘Tet HomaBAsOT poct P. acnes Ha 90%, a KomruecTBO CKK yMeHbutiaeres Ha 50%. OpTPOMMITAH, TeTpALLMKNAH, KH FANON He MITHONUIKTKH oKa3biBaloT MHTHGMpyioUree BIMSIHMe Ha XEMOTAKCHC 1 MakporparabHyi AKTHBHOCTS Helttpodbser08, Jn vitro Hin vivo noxasaHo mozysuspyrouee aelicrBue TeTpAUMKTHHA Ha BHIPAGOTKY UMTOKMHOB (HH- Tepreiikuta-1), OTBETCTRCHHDIX 34 MEMIMMPOBAHHE TIPO- ueccon Bocratenus (2, 26—28]. Kmeuueckas odibextasiocrs anrnGaKrepuanberx Mpenaparos saBcHtT B rlepByio O¥epeab OT Hx sUTTO*ILTE- 1, 2003