medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-010medsovet-7385Research ArticleЗАБОЛЕВАНИЯ КОЖИDERMAL DISEASESАктуальный взгляд на процессы рубцевания кожи и клинический опыт консервативного лечения келоидного рубцаActual view on skin scarring and clinical experience of conservative treatment of keloidshttps://orcid.org/0000-0001-5723-6573ЖуковаО. В.ZhukovaO. V.

Жукова Ольга Валентиновна, д.м.н., профессор, заведующая кафедрой дерматовенерологии, аллергологии и косметологии медицинского института; главный врач

117198, Россия, Москва, ул. Миклухо-Маклая, д. 6 

119071, Россия, Москва, Ленинский проспект, д. 17 

Olga V. Zhukova, Dr. Sci. (Med.), Professor, Head of the Department of Dermatovenereology, Allergology and Cosmetology, Institute of Medicine; Chief Medical Officer

6, Miklukho-Maklai St., Moscow, 117198, Russia

17, Leninskiy Ave., Moscow, 119071, Russia 

klinderma@inbox.ruhttps://orcid.org/0000-0001-6177-709XПоршинаО. В.PorshinaO. V.

Поршина Оксана Владимировна, к.м.н., заместитель главного врача по клинико-экспертной работе 

119071, Россия, Москва, Ленинский проспект, д. 17 

Oxana V. Porshina, Cand. Sci. (Med.), Dermatologist, Deputy Director

17, Leninskiy Ave., Moscow, 119071, Russia 

unleashed72@mail.ruhttps://orcid.org/0000-0003-3386-1467ОстрецоваМ. Н.OstretsovaM. N.

Острецова Мария Николаевна, к.м.н., доцент  кафедры дерматовенерологии, аллергологии и  косметологии медицинского института 

 117198, Россия, Москва, ул. Миклухо-Маклая, д. 6 

Maria N. Ostretsova, Cand. Sci. (Med.), Associate Professor, Department of Dermatovenereology, Allergology and Cosmetology, Institute of Medicine

6, Miklukho-Maklai St., Moscow, 117198, Russia 

ostretsova-mn@rudn.ruhttps://orcid.org/0000-0001-5039-4691ЛемытскаяВ. Е.LemytskayaV. E.

Лемытская Валентина Евгеньевна, аспирант кафедры дерматовенерологии, аллергологии и косметологии медицинского института 

 117198, Россия, Москва, ул. Миклухо-Маклая, д. 6 

Valentina E. Lemytskaya, Postgraduate Student, Department of Dermatovenereology, Allergology and Cosmetology, Institute of Medicine

6, Miklukho-Maklai St., Moscow, 117198, Russia 

lemytskaya@bk.ruРоссийский университет дружбы народов; Московский научно-практический центр дерматовенерологии и косметологииРоссияPeoples’ Friendship University of Russia; Moscow Scientific and Practical Center of Dermatovenereology and CosmetologyRussian FederationМосковский научно-практический центр дерматовенерологии и косметологииРоссияMoscow Scientific and Practical Center of Dermatovenereology and CosmetologyRussian FederationРоссийский университет дружбы народовРоссияPeoples’ Friendship University of RussiaRussian Federation202315032023022734Copyright © Жукова О.В., Поршина О.В., Острецова М.Н., Лемытская В.Е., 20232023Жукова О.В., Поршина О.В., Острецова М.Н., Лемытская В.Е.Zhukova O.V., Porshina O.V., Ostretsova M.N., Lemytskaya V.E.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7385

Рубцовые изменения кожи представляют собой актуальную проблему для многих областей практической медицины, в особенности для врачей-дерматовенерологов, косметологов и пластических хирургов. В развитых странах мира ежегодно у 100 млн пациентов появляются новые рубцы и около 11 млн из них являются келоидными. Вопрос дифференциальной диагностики келоидных и гипертрофических рубцов также до сих пор остается предметом дискуссий среди специалистов. Несмотря на большое разнообразие доступных методов лечения келоидных и гипертрофических рубцов, хирургическое иссечение, инъекции глюкокортикостероидов, лазерная терапия, криотерапия, компрессионная терапия и повязки с силиконом являются наиболее эффективными и обоснованными с точки зрения патогенеза методами для коррекции патологических рубцов. Перспективными методами терапии, об эффективности которых в последние годы появляется все больше зарубежных публикаций, считаются: инъекции интерферона, рекомбинантного полипептида TGF-β3 человека, обогащенной тромбоцитами плазмы, блокаторов кальциевых каналов, липофилинг, применение ингибиторов ангиотензинпревращающего фермента, крем на основе агонистов TLR-7, -8 (имиквимод и резиквимод), факторов роста, стволовых клеток. В статье представлен актуальный взгляд на процессы физиологического и патологического рубцевания, наиболее важные аспекты дифференциальной диагностики келоидных и гипертрофических рубцов, понимание которых важно для выбора верной стратегии терапии. Особое внимание уделено патофизиологическим механизмам действия, преимуществам и особенностям применения компрессионной терапии повязками (пластинами) на пластичной нетканой основе из полиуретана и вискозы, покрытой слоем мягкого силикона. Авторами приведен клинический опыт успешной двухэтапной коррекции келоидного рубца – постакне с применением инъекционной терапии ферментным препаратом на основе гиалуронидазы и силиконовых повязок.

Scars are an urgent issue for many areas of practical medicine, especially for dermatovenerologists, cosmetologists and plastic surgeons. Every year, 100 million patients develop new scars and about 11 million of them are keloid. The issue of differential diagnosis of keloid and hypertrophic scars is still the subject of discussion among specialists. Despite the wide variety of available methods of treatment of keloid and hypertrophic – surgical excision, injections of glucocorticosteroids, laser therapy, cryotherapy, compression therapy and silicone bandages are the most effective and pathogenically rationalised methods for the correction of pathological scars. Promising methods of therapy are: injections of interferon, recombinant human TGF-β3 polypeptide, platelet-rich plasma, calcium channel blockers, lipofilling, the use of angiotensin-converting enzyme inhibitors, creams based on imiquimod and resiquimod, growth factors, stem cells. The article presents an up-to-date view on the processes of physiological and pathological scarring, the most important aspects of the differential diagnosis of keloid and hypertrophic scars, the understanding of which is important for choosing the right therapeutic strategy. Particular attention is paid to the pathophysiological mechanisms of action, the advantages and features of the use of silicone dressings. The authors present the clinical experience of successful two-stage correction of keloid scar – post-acne with the use of injection therapy with hyaluronidase and silicone dressings.

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