medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2022-040medsovet-7395Research ArticleАЛЛЕРГОДЕРМАТОЗЫALLERGODERMATOSESКомплексная терапия хронических аллергодерматозовCombination therapy for managing chronic allergic dermatoseshttps://orcid.org/0000-0003-3420-4442СтадниковаА. С.StadnikovaA. S.

Стадникова Антонина Сергеевна, к.м.н., врач-дерматовенероло; ассистент кафедры  дерматовенерологии с курсом косметологии  факультета непрерывного медицинского образования 

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

125373, Россия, Москва, ул. Героев Панфиловцев, д. 28 

Antonina S. Stadnikova, Cand. Sci. (Med.), STD and Skin Specialist; Teaching Assistant, Department of Dermatovenerology with Cosmetology Course, Faculty of Continuing Medical Education

 28, Geroev Panfilovtsev St., Moscow, 125373, Russia 

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

tonya-st@yandex.ruhttps://orcid.org/0000-0002-7571-5460НовикГ. А.NovikG. A.

Новик Геннадий Айзикович, д.м.н., профессор, заведующий кафедрой педиатрии имени  профессора И.М. Воронцова 

194100, Россия, Санкт-Петербург, ул. Литовская, д. 2 

 Gennady A. Novik, Dr. Sci. (Med.), Professor, Head of the Department of Children’s Diseases named after Professor I.M. Vorontsov

2. Litovskaya St., St Petersburg, 194100, Russia 

ga_novik@mail.ruhttps://orcid.org/0000-0003-4615-7356БаграмоваГ. Э.BagramovaG. E.

Баграмова Гаянэ Эрнстовна, д.м.н., профессор  кафедры дерматовенерологии с курсом  косметологии факультета непрерывного  медицинского образования 

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

Gayaneh E. Bagramova, Dr. Sci. (Med.), Professor of the Department of Dermatovenerology with Cosmetology Course, Faculty of ContinuingMedical Education

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

bagramovaga@mail.ruhttps://orcid.org/0000-0002-2425-9346ВоробьеваА. С.VorobevaA. S.

Воробьева Александра Сергеевна, к.м.н., заведующая 1-м педиатрическим отделением 

 125373, Россия, Москва, ул. Героев Панфиловцев, д. 28 

Alexandra S. Vorobeva, Cand. Sci. (Med.), Head of Paediatrics Department No 1

28, Geroev Panfilovtsev St., Moscow, 125373, Russia 

dr.alexa@bk.ruРоссийский университет дружбы народов; Детская городская клиническая больница имени З.А. БашляевойРоссияBashlyaeva City Children’s Clinical Hospital; Peoples’ Friendship University of RussiaRussian FederationСанкт-Петербургский государственный педиатрический медицинский университетРоссияSt Petersburg State Pediatric Medical UniversityRussian FederationРоссийский университет дружбы народовРоссияPeoples’ Friendship University of RussiaRussian FederationДетская городская клиническая больница имени З.А. БашляевойРоссияBashlyaeva City Children’s Clinical HospitalRussian Federation20231603202302105112Copyright © Стадникова А.С., Новик Г.А., Баграмова Г.Э., Воробьева А.С., 20232023Стадникова А.С., Новик Г.А., Баграмова Г.Э., Воробьева А.С.Stadnikova A.S., Novik G.A., Bagramova G.E., Vorobeva A.S.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-sovet.pro/jour/article/view/7395

Атопический дерматит – воспалительное заболевание кожи, наиболее часто встречающееся среди детей, но также распространенное и у взрослых. Заболевание характеризуется как хроническое, однако только 20% детей страдают тяжелой формой атопического дерматита, тогда как другие 80% к 8 годам и раньше достигают многолетней ремиссии. В статье представлены основные сведения об атопическом дерматите, включая статистические эпидемиологические и патогенетические данные, сделаны акценты на проблемах качества жизни и стероидофобии больных. Известно, что в лечении атопического дерматита нередко используют сложные схемы терапии. В статье освещены подходы к тактике выбора наружной терапии согласно Европейским рекомендациям по лечению атопического дерматита 2018 г. Несмотря на то что топические ингибиторы кальциневрина появились около 15 лет назад, эта группа препаратов занимает главное место в лечении атопического дерматита благодаря выраженному противовоспалительному механизму действия со стероидсберегающим эффектом. В обзоре представлены основные механизмы действия топических ингибиторов кальциневрина и их влияние на барьерную функцию кожи. Представлены данные литературы по доказанной эффективности и высокому профилю безопасности самого первого препарата из группы топических ингибиторов кальциневрина – такролимуса. В статье авторы описали примеры успешного применения препарата такролимуса, способного подавлять активацию Т-лимфоцитов и снижать выработку провоспалительных цитокинов, у пациентов с атопическим дерматитом среднетяжелой и тяжелой степени тяжести, а также с другими хроническими аллергодерматозами. Применение препарата такролимус в представленных клинических случаях привело к уменьшению выраженности субъективных и объективных симптомов воспалительных заболеваний кожи.

Atopic dermatitis is an inflammatory skin disease that is most frequently occurred in children, but also common in adults. The disease is characterized as chronic, but only 20% of children have severe atopic dermatitis, while the other 80% achieve a longterm remission by the age of 8 and earlier. The article summarizes the main details about atopic dermatitis including statistical epidemiological and pathogenetic data, and places special emphasis on the issues of patients’ quality of life and steroidophobia. It is known that combination treatment regimens are often used in the treatment of atopic dermatitis. The article highlights approaches to the tactics of choosing topical therapy according to the European guidelines for the treatment of atopic dermatitis 2018. Despite the fact that topical calcineurin inhibitors were made available for the treatment about 15 years ago, this group of drugs take the lead in the treatment of atopic dermatitis due to a pronounced anti-inflammatory mechanism of action with a steroid-sparing effect. The review presents the main mechanisms of action of topical calcineurin inhibitors and their effect on the skin’s barrier function. Literature data on the proven efficacy and high safety profile of Tacrolimus, the very first drug from the topical calcineurin inhibitor group, are presented. In the article, the authors described examples of the successful use of Tacrolimus, which can suppress the T-lymphocyte activation and reduce the production of pro-inflammatory cytokines in patients with moderate to severe atopic dermatitis, as well as with other chronic allergic dermatoses. The use of Tacrolimus in the presented clinical cases led to a reduction of severity of subjective and objective symptoms of the inflammatory skin diseases.

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Proc Natl Acad Sci USA. 2001;98(17):9575–9580. https://doi.org/10.1073/pnas.161299698.Remitz A., Kyllönen H., Granlund H., Reitamo S. Tacrolimus ointment reduces staphylococcal colonization of atopic dermatitis lesions. J Allergy Clin Immunol. 2001;107(1):196–197. https://doi.org/10.1067/mai.2001.112131.Remitz A., Kyllönen H., Granlund H., Reitamo S. Tacrolimus ointment reduces staphylococcal colonization of atopic dermatitis lesions. J Allergy Clin Immunol. 2001;107(1):196–197. https://doi.org/10.1067/mai.2001.112131.Boguniewicz M., Fiedler V.C., Raimer S., Lawrence I.D., Hanifin J.M. A randomized, vehicle controlled trial of tacrolimus ointment for the treatment of atopic dermatitis in children. J Allergy Clin Immunol. 1998;102(4):637–644. https://doi.org/10.1016/s0091-6749(98)70281-7.Boguniewicz M., Fiedler V.C., Raimer S., Lawrence I.D., Hanifin J.M. A randomized, vehicle controlled trial of tacrolimus ointment for the treatment of atopic dermatitis in children. 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Skin and systemic pharmacokinetics of tacrolimus following topical application of tacrolimus ointment in adults with moderate to severe atopic dermatitis British J Dermatol. 2009;160(3):665–669. https://doi.org/10.1111/j.1365-2133.2008.08974.x.Eichenfield L.F., Tom W.L., Berger T.G., Krol A., Paller A.S., Schwarzenberger K. et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116–132. https://doi.org/10.1016/j.jaad.2014.03.023.Eichenfield L.F., Tom W.L., Berger T.G., Krol A., Paller A.S., Schwarzenberger K. et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116–132. https://doi.org/10.1016/j.jaad.2014.03.023.Wollenberg A., Barbarot S., Bieber T., Christen-Zaech S., Deleuran M., Fink-Wagner A. et al. 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The authors declare that there are no conflicts of interest present.