Обзор современных методов лечения мелазмы

Мелазма – распространенное, сложно поддающееся лечению пигментное заболевание кожи, характеризующееся рецидивирующим течением. В статье проведен обзор этиологии, патогенеза и принципов терапии мелазмы. Отмечена многофакторная природа заболевания, включающая генетическую предрасположенность, воздействие ультрафиолетового и видимого света и гормональные факторы. Известно, что видимый свет, особенно высокоэнергетический видимый свет с длиной волны 400–500 нм (High Energy Visibly Light, HEV-лучи, синий свет), и длинноволновые UVA-лучи (370–400 нм) усугубляют течение мелазмы. Подчеркнута важность комплексного подхода к лечению, включающего устранение триггерных факторов, патогенетическую терапию и обязательную фотопротекцию с использованием современных солнцезащитных средств широкого спектра действия. Особое внимание уделено необходимости информирования пациентов о хроническом характере мелазмы и важности пролонгированной терапии. В статье рассмотрена многоуровневая схема лечения, основанная на применении топических препаратов и пилингов в качестве терапии первой линии, с осторожным и взвешенным использованием аппаратных методов на последующих этапах. Описаны ключевые принципы терапии гиперпигментации, а именно ингибирование меланогенеза, снижение транспорта меланосом и ускорение процессов элиминации меланина. Приведены примеры современных депигментирующих наружных средств, содержащих тиамидол (патент Beiersdorf AG), которые способствуют улучшению mMASI (модифицированный индекс тяжести и площади мелазмы) уже через 2 нед. применения, и обосновано их применение для монои комбинированной терапии мелазмы. Предложенная трехступенчатая схема лечения, адаптированная к тяжести заболевания, позволяет оптимизировать терапевтическую тактику с учетом индивидуальных особенностей пациента.

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