Кольцевидная гранулёма: современные представления о патогенезе и патогенетически обоснованная терапия (обзор литературы)
- Авторы: Пахалаге Ч.А.1,2, Смирнова И.О.1,3, Пташникова П.Д.1
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Учреждения:
- Санкт-Петербургский государственный университет
- Ленинградский областной Центр специализированных видов медицинской помощи
- Городской кожно-венерологический диспансер
- Выпуск: Том 28, № 1 (2025)
- Страницы: 27-40
- Раздел: ДЕРМАТОЛОГИЯ
- URL: https://bakhtiniada.ru/1560-9588/article/view/313049
- DOI: https://doi.org/10.17816/dv637126
- ID: 313049
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Аннотация
Кольцевидная гранулёма ― хроническое доброкачественное неинфекционное заболевание кожи, проявляющееся кольцевидными папулами, чаще всего на руках и ногах. Заболевание считают редким: по некоторым данным, им поражено менее 0,04% населения. Однако в последние годы отмечается рост заболеваемости дерматозом, что связывают с высокой распространённостью инфекционных заболеваний, в том числе инфекции, вызванной коронавирусом SARS-CoV-2. Патогенез кольцевидной гранулёмы до конца не расшифрован, тем не менее в ходе сравнительного анализа широкого спектра биомаркеров в биоптатах поражённой кожи констатированы различия в экспрессии генов, участвующих в регуляции врождённого иммунитета, Th1 и Th2 лимфоцитов, янус-киназ. Ассоциации кольцевидной гранулёмы с эндокринными, иммунными и аутоиммунными болезнями, злокачественными новообразованиями, а также триггерная роль инфекций и вакцинации являются предметном обсуждения, несмотря на достижения в понимании молекулярных механизмов развития болезни.
Лечение кольцевидной гранулёмы представляет собою довольно сложную задачу. Топические кортикостероиды могут быть эффективны при ограниченных формах заболевания. В комбинации с ними возможно использование ингибиторов кальциневрина. При диссеминированных формах дерматоза назначают узкополосную средневолновую ультрафиолетовую терапию 311 нм, ПУВА, терапию эксимерным ультрафиолетовым светом 308 нм. Имеются описания эффективности антибактериальных препаратов. В настоящее время в качестве таргетной терапии кольцевидной гранулёмы предлагают использовать ингибиторы фактора некроза опухоли (TNF-α), янус-киназ (JAK) и интерлейкина-23 (IL-23). Основанием для такой рекомендации являются новые сведения о патогенезе кольцевидной гранулёмы.
Представленный обзор литературы систематизирует современные представления о молекулярных и клеточных механизмах развития заболевания, инфекционных и неинфекционных триггерах воспаления, роли эндокринной, иммунной и онкологической патологии как предрасполагающих факторах. Существенное значение уделяется анализу методов терапии заболевания.
Ключевые слова: кольцевидная гранулёма; патогенез; триггеры; предрасполагающие факторы; наружная терапия; системная терапия.
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Чанилка Абегунавардана Пахалаге
Санкт-Петербургский государственный университет; Ленинградский областной Центр специализированных видов медицинской помощи
Автор, ответственный за переписку.
Email: chanilka92@hotmail.com
ORCID iD: 0000-0002-1713-4123
SPIN-код: 2828-8975
Россия, Санкт-Петербург; Санкт-Петербург
Ирина Олеговна Смирнова
Санкт-Петербургский государственный университет; Городской кожно-венерологический диспансер
Email: driosmirnova@yandex.ru
ORCID iD: 0000-0001-8584-615X
SPIN-код: 5518-6453
д-р мед. наук, профессор
Россия, Санкт-Петербург; Санкт-ПетербургПолина Дмитриевна Пташникова
Санкт-Петербургский государственный университет
Email: enternita7@yandex.ru
ORCID iD: 0000-0003-4699-1746
SPIN-код: 8715-3940
Россия, Санкт-Петербург
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