Акне и розацеа: сходства и различия

Церикидзе Н.Г., Сакания Л.Р., Корсунская И.М. Акне и розацеа: сходства и различия. Consilium Medicum. 2024;26(8):530–534. DOI: 10.26442/20751753.2024.8.202957

© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.

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Tserikidze NG, Sakaniya LR, Korsunskaya IM. Acne and rosacea: similarities and differences. A review. Consilium Medicum. 2024;26(8):530–534. DOI: 10.26442/20751753.2024.8.202957

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Аннотация

Акне и розацеа часто встречаются в клинической практике дерматолога. Данные заболевания могут развиться одновременно у одного пациента. Чаще всего с акне сочетается эритематозная форма розацеа. Из-за схожести клинических проявлений с акне диагноз розацеа может быть легко пропущен. Общими патогенетическими факторами двух заболеваний считаются генетика, изменение в микробиоме, иммунные нарушения и дисфункция кожного барьера. Работ, посвященных взаимосвязи акне и розацеа, немного. Недавнее исследование выявило ряд общих дифференциально экспрессируемых генов, среди которых ИЛ-1B и ММР9, а также показало, что гамма-дельта-Т-клетки могут играть важную роль в развитии обоих заболеваний. Несмотря на общность патогенеза и схожесть некоторых клинических проявлений (папул и пустул), акне и розацеа необходимо различать. При розацеа наблюдается стойкая эритема лица, индуцируемая сосудорегулирующими нейтропептидами, тогда как при акне воспалительный процесс возникает из-за избытка кожного сала и изменений микробиома кожи. Для системной терапии обоих заболеваний применяется изотретиноин. Препарат оказывает влияние на уровень некоторых цитокинов, в том числе ингибирует экспрессию матриксной MMP9. Кроме того, он снижает выработку кожного сала при акне, а за счет его способности изменять микроокружение кожи позволяет снизить количество Propionibacterium acnes при акне и Demodex folliculorum при розацеа. Суточные и куммулятивные дозы при розацеа и акне будут различаться, как и топическая терапия при данных заболеваниях. Для лечения акне хорошо зарекомендовало себя сочетание клиндамицина и бензоила пероксида, позволяющее быстро добиться значимого клинического эффекта. При розацеа в качестве топического средства рекомендовано применять метронидазол в кремовой форме, которая обладает лучшей переносимостью. У пациентов, одновременно страдающих обоими заболеваниями, для снятия острого воспаления необходимо использовать комбинацию клиндамицина и бензоила пероксида, после чего возможно перейти на применение метронидазола.

Ключевые слова: акне, розацеа, изотретиноин, метронидазол, клиндамицин, бензоила пероксид

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Acne and rosacea are frequently encountered in the clinical practice of a dermatologist. These diseases can develop simultaneously in the same patient. Most often, the erythematous form of rosacea is combined with acne. Because of the similarity of clinical manifestations with acne, the diagnosis of rosacea can be easily missed. Common pathogenetic factors in the 2 diseases are thought to be genetics, alterations in the microbiome, immune disorders, and skin barrier dysfunction. There are few works addressing the relationship between acne and rosacea. A recent study identified a number of common differentially expressed genes, including interleukin-1B and matrix metalloproteinase 9, and showed that gamma delta T cells may play an important role in the development of both diseases. Despite the common pathogenesis and the similarity of some clinical manifestations (papules and pustules), acne and rosacea must be distinguished. In rosacea, there is persistent facial erythema induced by vasoregulatory neutropeptides, whereas in acne, the inflammatory process is due to excess sebum and changes in the skin microbiome. Isotretinoin is used for systemic therapy of both diseases. The drug affects the level of some cytokines, including inhibiting the expression of matrix metalloproteinase 9. In addition, it reduces sebum production in acne, and due to its ability to alter the skin microenvironment, it can reduce Propionibacterium acnes in acne and Demodex folliculorum in rosacea. Daily and cumulative doses for rosacea and acne will differ, as will topical therapy for these conditions. For acne, the combination of clindamycin and benzoyl peroxide is well established for the treatment of acne, allowing rapid meaningful clinical effect. In rosacea, metronidazole in cream form, which has better tolerability, is recommended as a topical agent. In patients suffering from both diseases simultaneously, a combination of clindamycin and benzoyl peroxide should be used to relieve acute inflammation, after which it is possible to switch to metronidazole.

Keywords: acne, rosacea, isotretinoin, metronidazole, clindamycin, benzoyl peroxide

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Список литературы

1. Chen H, Lai W, Zheng Y. Rosacea in acne vulgaris patients: subtype distribution and triggers assessment. A cross-sectional study. J Cosmet Dermatol. 2021;20(6):1889-86. DOI:10.1111/jocd.13762
2. Liang J, Chen Y, Wang Z, et al. Exploring the association between rosacea and acne by integrated bioinformatics analysis. Sci Rep. 2024;14(1):3065. DOI:10.1038/s41598-024-53453-x
3. Kelhälä HL, Palatsi R, Fyhrquist N, et al. IL-17/Th17 pathway is activated in acne lesions. PLoS One. 2014;9(8):e105238. DOI:10.1371/journal.pone.0105238
4. Ahn CS, Huang WW. Rosacea Pathogenesis. Dermatol Clin. 2018;36(2):81-6. DOI:10.1016/j.det.2017.11.001
5. Beylot C, Auffret N, Poli F, et al. Propionibacterium acnes: an update on its role in the pathogenesis of acne. J Eur Acad Dermatol Venereol. 2014;28(3):271-8. DOI:10.1111/jdv.12224
6. Marson JW, Baldwin HE. Rosacea: a wholistic review and update from pathogenesis to diagnosis and therapy. Int J Dermatol. 2020;59(6):e175-12. DOI:10.1111/ijd.14757
7. Rodrigues-Braz D, Zhao M, Yesilirmak N, et al. Cutaneous and ocular rosacea: common and specific physiopathogenic mechanisms and study models. Mol Vis. 2021;27:323-53.
8. Schaller M, Almeida LMC, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. 2020;182(5):1269-26. DOI:10.1111/bjd.18420
9. Huang YC, Yang CH, Li TT, et al. Cell-free extracts of Propionibacterium acnes stimulate cytokine production through activation of p38 MAPK and Toll-like receptor in SZ95 sebocytes. Life Sci. 2015;139:123-31. DOI:10.1016/j.lfs.2015.07.028
10. Kwon HH, Moon KR, Park SY, et al. Daylight photodynamic therapy with 1.5% 3-butenyl 5-aminolevulinate gel as a convenient, effective and safe therapy in acne treatment: a double-blind randomized controlled trial. J Dermatol. 2016;43(5):515-21. DOI:10.1111/1346-8138.13191
11. Lim HJ, Kang SH, Song YJ, et al. Inhibitory Effect of Quercetin on Propionibacterium acnes-induced Skin Inflammation. Int Immunopharmacol. 2021;96:107557. DOI:10.1016/j.intimp.2021.107557
12. Papakonstantinou E, Aletras AJ, Glass E, et al. Matrix metalloproteinases of epithelial origin in facial sebum of patients with acne and their regulation by isotretinoin. J Invest Dermatol. 2005;125(4):673-84. DOI:10.1111/j.0022-202X.2005.23848.x
13. Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1(3):162-9. DOI:10.4161/derm.1.3.9364
14. Nelson AM, Gilliland KL, Cong Z, Thiboutot DM. 13-cis Retinoic acid induces apoptosis and cell cycle arrest in human SEB-1 sebocytes. J Invest Dermatol. 2006;126(10):2178-89. DOI:10.1038/sj.jid.5700289
15. Dispenza MC, Wolpert EB, Gilliland KL, et al. Systemic isotretinoin therapy normalizes exaggerated TLR-2-mediated innate immune responses in acne patients. J Invest Dermatol. 2012;132(9):2198-05. DOI:10.1038/jid.2012.111
16. Meyskens FL Jr, Gilmartin E, Alberts DS, et al. Activity of isotretinoin against squamous cell cancers and preneoplastic lesions. Cancer Treat Rep. 1982;66(6):1315-9.
17. Layton AM, Dreno B, Gollnick HP, Zouboulis CC. A review of the European Directive for prescribing systemic isotretinoin for acne vulgaris. J Eur Acad Dermatol Venereol. 2006;20(7):773-6. DOI:10.1111/j.1468-3083.2006.01671.x
18. Guruvayoorappan C, Kuttan G. 13 cis-retinoic acid regulates cytokine production and inhibits angiogenesis by disrupting endothelial cell migration and tube formation. J Exp Ther Oncol. 2008;7(3):173-82.
19. Paichitrojjana A, Paichitrojjana A. Successful treatment of ivermectin refractory demodicosis with isotretinoin and permethrin cream. JAAD Case Rep. 2022;26:98-100. DOI:10.1016/j.jdcr.2022.06.017
20. Chu S, Michelle L, Ekelem C, et al. Oral isotretinoin for the treatment of dermatologic conditions other than acne: a systematic review and discussion of future directions. Arch Dermatol Res. 2021;313(6):391-430. DOI:10.1007/s00403-020-02152-4
21. Ertl GA, Levine N, Kligman AM. A comparison of the efficacy of topical tretinoin and low-dose oral isotretinoin in rosacea. Arch Dermatol. 1994;130(3):319-24.
22. Gollnick H, Blume-Peytavi U, Szabó EL, et al. Systemic isotretinoin in the treatment of rosacea – doxycycline- and placebo-controlled, randomized clinical study. J Dtsch Dermatol Ges. 2010;8(7):505-15. DOI:10.1111/j.1610-0387.2010.07345.x
23. Sbidian E, Vicaut É, Chidiack H, et al. A Randomized-Controlled Trial of Oral Low-Dose Isotretinoin for Difficult-To-Treat Papulopustular Rosacea. J Invest Dermatol.
2016;136(6):1124-19. DOI:10.1016/j.jid.2016.01.025
24. Shemer A, Gupta AK, Kassem R, et al. Low-dose isotretinoin versus minocycline in the treatment of rosacea. Dermatol Ther. 2021;34(4):e14986. DOI:10.1111/dth.14986
25. Rademaker M. Very low-dose isotretinoin in mild to moderate papulopustular rosacea; a retrospective review of 52 patients. Australas J Dermatol. 2018;59(1):26-30. DOI:10.1111/ajd.12522
26. Mayur O, Martinez R, McNichol MC, McGee JS. Clinical and histological features and treatment outcomes of patients with Morbihan disease: a systematic review. Arch Dermatol Res. 2023;315(8):2427-49. DOI:10.1007/s00403-023-02621-6
27. Сакания Л.Р., Пирузян А.Л., Корсунская И.М. Акне у пациентов, активно занимающихся спортом: особенности ведения. Клиническая дерматология и венерология. 2021;20(2):82-6 [Sakaniya LR, Piruzyan AL, Korsunskaya IM. Acne in patients actively involved in sports: features of medical care. Russian Journal of Clinical Dermatology and Venereology. 2021;20(2):82‑6 (in Russian)]. DOI:10.17116/klinderma20212002182
28. Сакания Л.Р., Мильдзихова Д.Р., Пирузян А.Л., Корсунская И.М. Стратегия терапии среднетяжелых и тяжелых форм акне. Клиническая дерматология и венерология. 2022;21(3):400-3 [Sakaniya LR, Mildzikhova DR, Piruzyan AL, Korsunskaya IM. Therapy strategy for moderate to severe acne. Russian Journal of Clinical Dermatology and Venereology. 2022;21(3):400‑3 (in Russian)]. DOI:10.17116/klinderma202221031400
29. Мильдзихова ДР, Сакания ЛР, Церикидзе НГ, Корсунская ИМ. Проблема терапии акне и розацеа у женщин репродуктивного возраста. Медицинский Совет. 2024;18(2):54-8 [Mildzikhova DR, Sakaniya LR, Tserikidze NG, Korsunskaya IM. The problem of treating acne and rosacea in women of reproductive age. Meditsinskiy Sovet = Medical Council. 2024;18(2):54-8 (in Russian)]. DOI:10.21518/ms2024-016
30. Соркина И.Л., Сакания Л.Р., Троянова С.Ю., Корсунская И.М. Пути повышения приверженности лечению пациентов с розацеа. Клиническая дерматология и венерология. 2017;16(4):66-71 [Sorkina IL, Sakaniia LR, Troyanova SYu, Korsunskaia IM. Improving adherence to treatment in patients with rosacea. Russian Journal of Clinical Dermatology and Venereology. 2017;16(4):66‑71 (in Russian)]. DOI:10.17116/klinderma201716466-70
31. Zouboulis CC, Fischer TC, Wohlrab J, et al. Study of the efficacy, tolerability, and safety of 2 fixed-dose combination gels in the management of acne vulgaris. Cutis. 2009;84(4):223-9.
32. Green L, Cirigliano M, Gwazdauskas JA, Gonzalez P. The Tolerability Profile of Clindamycin 1%/Benzoyl Peroxide 5% Gel vs. Adapalene 0.1%/Benzoyl Peroxide 2.5% Gel for Facial Acne: Results of Two Randomized, Single-Blind, Split-Face Studies. J Clin Aesthet Dermatol. 2012;5(5):16-24.
33. Мильдзихова Д.Р., Пирузян А.Л., Корсунская И.М. Акне у беременных. Клиническая дерматология и венерология. 2023;22(1):70-4 [Mildzikhova DR, Piruzyan AL, Korsunskaya IM. Acne in pregnant women. Russian Journal of Clinical Dermatology and Venereology. 2023;22(1):70‑4 (in Russian)]. DOI:10.17116/klinderma20232201170
34. Троянова С.Ю., Корсунская И.М., Соркина И.Л., Соболев В.В. Обоснование эффективности метронидазола в терапии розацеа. Клиническая дерматология и венерология. 2017;16(5):45-8 [Troyanova SYu, Korsunskaia IM, Sorkina IL, Sobolev VV. Justification of the efficacy of metronidazole in the treatment of rosacea. Russian Journal of Clinical Dermatology and Venereology. 2017;16(5):45‑8 (in Russian)]. DOI:10.17116/klinderma201716545-48
35. Williamson T, Cheng WY, McCormick N, Vekeman F. Patient Preferences and Therapeutic Satisfaction with Topical Agents for Rosacea: A Survey-Based Study. Am Health Drug Benefits. 2018;11(2):97-106.
36. Solanki HK, Shah DA, Maheriya PM, Patel CA. Evaluation of anti-inflammatory activity of probiotic on carrageenan-induced paw edema in Wistar rats. Int J Biol Macromol. 2015;72:1277-82. DOI:10.1016/j.ijbiomac.2014.09.059

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1. Chen H, Lai W, Zheng Y. Rosacea in acne vulgaris patients: subtype distribution and triggers assessment. A cross-sectional study. J Cosmet Dermatol. 2021;20(6):1889-86. DOI:10.1111/jocd.13762
2. Liang J, Chen Y, Wang Z, et al. Exploring the association between rosacea and acne by integrated bioinformatics analysis. Sci Rep. 2024;14(1):3065. DOI:10.1038/s41598-024-53453-x
3. Kelhälä HL, Palatsi R, Fyhrquist N, et al. IL-17/Th17 pathway is activated in acne lesions. PLoS One. 2014;9(8):e105238. DOI:10.1371/journal.pone.0105238
4. Ahn CS, Huang WW. Rosacea Pathogenesis. Dermatol Clin. 2018;36(2):81-6. DOI:10.1016/j.det.2017.11.001
5. Beylot C, Auffret N, Poli F, et al. Propionibacterium acnes: an update on its role in the pathogenesis of acne. J Eur Acad Dermatol Venereol. 2014;28(3):271-8. DOI:10.1111/jdv.12224
6. Marson JW, Baldwin HE. Rosacea: a wholistic review and update from pathogenesis to diagnosis and therapy. Int J Dermatol. 2020;59(6):e175-12. DOI:10.1111/ijd.14757
7. Rodrigues-Braz D, Zhao M, Yesilirmak N, et al. Cutaneous and ocular rosacea: common and specific physiopathogenic mechanisms and study models. Mol Vis. 2021;27:323-53.
8. Schaller M, Almeida LMC, Bewley A, et al. Recommendations for rosacea diagnosis, classification and management: update from the global ROSacea COnsensus 2019 panel. Br J Dermatol. 2020;182(5):1269-26. DOI:10.1111/bjd.18420
9. Huang YC, Yang CH, Li TT, et al. Cell-free extracts of Propionibacterium acnes stimulate cytokine production through activation of p38 MAPK and Toll-like receptor in SZ95 sebocytes. Life Sci. 2015;139:123-31. DOI:10.1016/j.lfs.2015.07.028
10. Kwon HH, Moon KR, Park SY, et al. Daylight photodynamic therapy with 1.5% 3-butenyl 5-aminolevulinate gel as a convenient, effective and safe therapy in acne treatment: a double-blind randomized controlled trial. J Dermatol. 2016;43(5):515-21. DOI:10.1111/1346-8138.13191
11. Lim HJ, Kang SH, Song YJ, et al. Inhibitory Effect of Quercetin on Propionibacterium acnes-induced Skin Inflammation. Int Immunopharmacol. 2021;96:107557. DOI:10.1016/j.intimp.2021.107557
12. Papakonstantinou E, Aletras AJ, Glass E, et al. Matrix metalloproteinases of epithelial origin in facial sebum of patients with acne and their regulation by isotretinoin. J Invest Dermatol. 2005;125(4):673-84. DOI:10.1111/j.0022-202X.2005.23848.x
13. Layton A. The use of isotretinoin in acne. Dermatoendocrinol. 2009;1(3):162-9. DOI:10.4161/derm.1.3.9364
14. Nelson AM, Gilliland KL, Cong Z, Thiboutot DM. 13-cis Retinoic acid induces apoptosis and cell cycle arrest in human SEB-1 sebocytes. J Invest Dermatol. 2006;126(10):2178-89. DOI:10.1038/sj.jid.5700289
15. Dispenza MC, Wolpert EB, Gilliland KL, et al. Systemic isotretinoin therapy normalizes exaggerated TLR-2-mediated innate immune responses in acne patients. J Invest Dermatol. 2012;132(9):2198-05. DOI:10.1038/jid.2012.111
16. Meyskens FL Jr, Gilmartin E, Alberts DS, et al. Activity of isotretinoin against squamous cell cancers and preneoplastic lesions. Cancer Treat Rep. 1982;66(6):1315-9.
17. Layton AM, Dreno B, Gollnick HP, Zouboulis CC. A review of the European Directive for prescribing systemic isotretinoin for acne vulgaris. J Eur Acad Dermatol Venereol. 2006;20(7):773-6. DOI:10.1111/j.1468-3083.2006.01671.x
18. Guruvayoorappan C, Kuttan G. 13 cis-retinoic acid regulates cytokine production and inhibits angiogenesis by disrupting endothelial cell migration and tube formation. J Exp Ther Oncol. 2008;7(3):173-82.
19. Paichitrojjana A, Paichitrojjana A. Successful treatment of ivermectin refractory demodicosis with isotretinoin and permethrin cream. JAAD Case Rep. 2022;26:98-100. DOI:10.1016/j.jdcr.2022.06.017
20. Chu S, Michelle L, Ekelem C, et al. Oral isotretinoin for the treatment of dermatologic conditions other than acne: a systematic review and discussion of future directions. Arch Dermatol Res. 2021;313(6):391-430. DOI:10.1007/s00403-020-02152-4
21. Ertl GA, Levine N, Kligman AM. A comparison of the efficacy of topical tretinoin and low-dose oral isotretinoin in rosacea. Arch Dermatol. 1994;130(3):319-24.
22. Gollnick H, Blume-Peytavi U, Szabó EL, et al. Systemic isotretinoin in the treatment of rosacea – doxycycline- and placebo-controlled, randomized clinical study. J Dtsch Dermatol Ges. 2010;8(7):505-15. DOI:10.1111/j.1610-0387.2010.07345.x
23. Sbidian E, Vicaut É, Chidiack H, et al. A Randomized-Controlled Trial of Oral Low-Dose Isotretinoin for Difficult-To-Treat Papulopustular Rosacea. J Invest Dermatol.
2016;136(6):1124-19. DOI:10.1016/j.jid.2016.01.025
24. Shemer A, Gupta AK, Kassem R, et al. Low-dose isotretinoin versus minocycline in the treatment of rosacea. Dermatol Ther. 2021;34(4):e14986. DOI:10.1111/dth.14986
25. Rademaker M. Very low-dose isotretinoin in mild to moderate papulopustular rosacea; a retrospective review of 52 patients. Australas J Dermatol. 2018;59(1):26-30. DOI:10.1111/ajd.12522
26. Mayur O, Martinez R, McNichol MC, McGee JS. Clinical and histological features and treatment outcomes of patients with Morbihan disease: a systematic review. Arch Dermatol Res. 2023;315(8):2427-49. DOI:10.1007/s00403-023-02621-6
27. Sakaniya LR, Piruzyan AL, Korsunskaya IM. Acne in patients actively involved in sports: features of medical care. Russian Journal of Clinical Dermatology and Venereology. 2021;20(2):82‑6 (in Russian). DOI:10.17116/klinderma20212002182
28. Sakaniya LR, Mildzikhova DR, Piruzyan AL, Korsunskaya IM. Therapy strategy for moderate to severe acne. Russian Journal of Clinical Dermatology and Venereology. 2022;21(3):400‑3 (in Russian). DOI:10.17116/klinderma202221031400
29. Mildzikhova DR, Sakaniya LR, Tserikidze NG, Korsunskaya IM. The problem of treating acne and rosacea in women of reproductive age. Meditsinskiy Sovet = Medical Council. 2024;18(2):54-8 (in Russian). DOI:10.21518/ms2024-016
30. Sorkina IL, Sakaniia LR, Troyanova SYu, Korsunskaia IM. Improving adherence to treatment in patients with rosacea. Russian Journal of Clinical Dermatology and Venereology. 2017;16(4):66‑71 (in Russian). DOI:10.17116/klinderma201716466-70
31. Zouboulis CC, Fischer TC, Wohlrab J, et al. Study of the efficacy, tolerability, and safety of 2 fixed-dose combination gels in the management of acne vulgaris. Cutis. 2009;84(4):223-9.
32. Green L, Cirigliano M, Gwazdauskas JA, Gonzalez P. The Tolerability Profile of Clindamycin 1%/Benzoyl Peroxide 5% Gel vs. Adapalene 0.1%/Benzoyl Peroxide 2.5% Gel for Facial Acne: Results of Two Randomized, Single-Blind, Split-Face Studies. J Clin Aesthet Dermatol. 2012;5(5):16-24.
33. Mildzikhova DR, Piruzyan AL, Korsunskaya IM. Acne in pregnant women. Russian Journal of Clinical Dermatology and Venereology. 2023;22(1):70‑4 (in Russian). DOI:10.17116/klinderma20232201170
34. Troyanova SYu, Korsunskaia IM, Sorkina IL, Sobolev VV. Justification of the efficacy of metronidazole in the treatment of rosacea. Russian Journal of Clinical Dermatology and Venereology. 2017;16(5):45‑8 (in Russian). DOI:10.17116/klinderma201716545-48
35. Williamson T, Cheng WY, McCormick N, Vekeman F. Patient Preferences and Therapeutic Satisfaction with Topical Agents for Rosacea: A Survey-Based Study. Am Health Drug Benefits. 2018;11(2):97-106.
36. Solanki HK, Shah DA, Maheriya PM, Patel CA. Evaluation of anti-inflammatory activity of probiotic on carrageenan-induced paw edema in Wistar rats. Int J Biol Macromol. 2015;72:1277-82. DOI:10.1016/j.ijbiomac.2014.09.059

Авторы

Н.Г. Церикидзе¹, Л.Р. Сакания^1,2, И.М. Корсунская*²

¹ГБУЗ «Московский научно-практический центр дерматовенерологии и косметологии» Департамента здравоохранения г. Москвы, Москва, Россия;
²ФГБУН «Центр теоретических проблем физико-химической фармакологии РАН», Москва, Россия
*marykor@bk.ru

________________________________________________

Natalia G. Tserikidze¹, Luiza R. Sakaniya^1,2, Irina M. Korsunskaya*²

¹Moscow Scientific and Practical Center of Dermatology, Venereology and Cosmetology, Moscow, Russia;
²Center for Theoretical Problems of Physicochemical Pharmacology of the Russian Academy of Sciences, Moscow, Russia
*marykor@bk.ru

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