Russian Journal of AllergyRussian Journal of AllergyРоссийский Аллергологический Журнал1810-88302686-682XPublishing House ABV Press30210.36691/RJA302ArticlesСтатьиResearch ArticlePERSISTENT SUBCLINICAL INFLAMMATION IN THE SKIN AS A RISK FACTOR FOR RELAPSE IN ATOPIC DERMATITIS: FROM PATHOPHYSIOLOGY TO TREATMENTПЕРСИСТИРУЮЩЕЕ СУБКЛИНИЧЕСКОЕ ВОСПАЛЕНИЕ В КОЖЕ КАК ФАКТОР РИСКА ОБОСТРЕНИЙ АТОПИЧЕСКОГО ДЕРМАТИТА: ОТ ПАТОФИЗИОЛОГИИ К ЛЕЧЕНИЮKalyuzhinO VКалюжинОлег Витальевич

профессор

kalyuzhin@list.ruI.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian FederationФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М Сеченова» Минздрава России (Сеченовский университет)15102017144-5VOL 14, NO4-5 (2017)ТОМ 14, №4-5 (2017)10811910032020Copyright ©; 2017, Pharmarus Print MediaCopyright ©; 2017, Фармарус Принт Медиа2017Pharmarus Print MediaФармарус Принт Медиаhttps://rusalljournal.ru/raj/article/view/302

Lowgrade cutaneous inflammation, which persists after induction of remission of atopic dermatitis (AD), determines the risk of repeated relapses and progression of the disease. It has been well established that subclinical inflammation in the skin of atopic patients may be inhibited by topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI), and proactive courses of these drugs prolong remission of the disease. In terms of prolonged application, TCI have some advantages over TCS in the context of safety. However, the routine use of TCI in AD is constrained by many practitioners who do not accept the concept of subclinical chronic inflammation and the strategy of maintenance antiinflammatory therapy on areas prone to repeated relapses, as well as obsolete myths about the association of TCI application with increased risk of cutaneous lymphoma. The review presents modem data on the pathophysiology of AD with a focus on subclinical skin inflammation, which persists after regression of acute manifestations of the disease, and the possibilities of suppressing this inflammation with TCI. Data on the safety of TCI for longterm use and the absence of prooncogenic potential are given. In addition, the relevance and expediency of pimecrolimus use in children under 2 years of age are emphasized.

Низкоуровневое воспаление в коже, персистирующее после индукции ремиссии атопического дерматита (АтД), определяет риск повторных обострений и прогрессирования заболевания. Доказано, что субклиническое воспаление в коже при АтД поддается контролю топическими кортикостероидами (ТКС) и топическими ингибиторами кальциневрина (ТИК), а поддерживающее лечение этими препаратами вне активной фазы заболевания продлевает его ремиссию. При пролонгированном применении ТИК имеют некоторые преимущества над ТКС как более безопасные. Вместе с тем широкое проактивное применение ТИК сдерживается непринятием многими практикующими врачами концепции субклинического хронического воспаления и стратегии поддерживающего противовоспалительного лечения на участках кожи, подверженных повторным поражениям, а также ошибочными представлениями о связи использования ТИК с риском развития лимфомы кожи. В обзоре представлены современные данные о патофизиологии АтД с фокусированием на субклиническом воспалении кожи, персистирующем после регрессии острых проявлений заболевания, и возможностях подавления этого воспаления при помощи использования ТИК. Приводятся данные о безопасности ТИК при длительном применении и отсутствии у них проонкогенного потенциала. Кроме того, подчеркивается востребованность и обоснованность использования пимекролимуса у детей в возрасте до 2 лет.

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