Vestnik dermatologii i venerologiiVestnik dermatologii i venerologiiВестник дерматологии и венерологии0042-46092313-6294Rossijskoe Obschestvo Dermatovenerologov i Kosmetologov1470110.25208/vdv14701REVIEWSОБЗОР ЛИТЕРАТУРЫReview ArticlePathogenetic therapy of rosacea with systemic tetracyclinesПатогенетическая терапия розацеа системными тетрациклинамиhttps://orcid.org/0000-0002-9458-08722287-5062SamtsovAlexey V.СамцовАлексей Викторович
Russian Federation

MD, Dr. Sci. (Med.), Professor

доктор медицинских наук, профессор

avsamtsov@mail.ruMilitary Medical Academy named after S.M. KirovВоенно-медицинская академия имени С.М. Кирова181220233012202399623282507202314112023Copyright ©; 2024, Samtsov A.V.Copyright ©; 2024, Самцов А.В.2024Samtsov A.V.Самцов А.В.https://creativecommons.org/licenses/by-nc/4.0https://vestnikdv.ru/jour/article/view/14701

The article presents modern data on the pathophysiology of rosacea and diagnostic criteria for dermatosis. The historical aspects of the introduction of systemic tetracyclines into the therapy of rosacea are outlined. The effect of doxycycline and minocycline on the mechanisms of rosacea development is covered in detail, taking into account modern ideas about the pathogenesis of the disease. At the same time, the advantage of minocycline, compared with doxycycline, is noted, which is manifested by a more pronounced anti-inflammatory effect, as well as a higher antibacterial efficacy, which allows the use of low dosages of minocycline and thereby reduces the risk of adverse events, especially from the gastrointestinal tract. The data of various studies are presented, indicating the expediency of prescribing subantimicrobial doses, as well as the results of evaluating the effectiveness and safety of domestic minocycline — minoleksin. It has been proven that the effectiveness of tetracyclines is associated with a pathogenetic effect on innate immunity reactions, with a pronounced anti-inflammatory effect, especially minocycline, suppression of a number of microorganisms, which, apparently, are not a key link in the pathogenesis of rosacea but can be a trigger factor and initiate inflammation. In addition, minocycline most effectively inhibits the activity of metalloproteinases and increases epidermal hydration.

В статье приводятся современные данные о патофизиологии розацеа и диагностических критериях дерматоза. Излагаются исторические аспекты введения в терапию розацеа системных тетрациклинов. Подробно освещено влияние доксициклина и миноциклина на механизмы развития розацеа с учетом современных представлений о патогенезе заболевания. Отмечается преимущество миноциклина по сравнению с доксициклином, проявляющееся более выраженным противовоспалительным действием, а также более высокой антибактериальной эффективностью, что позволяет применять низкие дозировки миноциклина и тем самым снижать риск развития нежелательных явлений, особенно со стороны желудочно-кишечного тракта. Приводятся данные различных исследований, свидетельствующих о целесообразности назначения субантимикробных доз, а также результаты оценки эффективности и безопасности отечественного миноциклина — минолексина. Доказано, что эффективность тетрациклинов связана с патогенетическим воздействием на реакции врожденного иммунитета, с выраженным противовоспалительным эффектом, особенно миноциклина, подавлением ряда микроорганизмов, которые, по-видимому, не являются ключевым звеном патогенеза розацеа, однако могут быть триггерным фактором и инициировать воспаление. Кроме того, миноциклин наиболее эффективно ингибирует активность металлопротеиназ и увеличивает гидратацию эпидермиса.

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