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Келоидные и гипертрофические рубцы. Часть 4 из 4

Блеомицин

Инъекции вызывают некроз кератиноцитов. Он не одобрен FDA для использования в лечении гипертрофических и келоидных рубцов.

Фторурацил для местного применения (адруцил)

Фторурацил - это аналог пиримидина, который ингибирует пролиферацию фибробластов в культуре тканей и, как полагают, уменьшает послеоперационное рубцевание за счет уменьшения пролиферации фибробластов. Он не одобрен FDA для использования в лечении гипертрофических и келоидных рубцов.

Доксорубицин (адриамицин)

Доксорубицин необратимо инактивирует пролил 4-гидроксилазу в фибробластах кожи человека и ингибирует набор альфа-цепей коллагена. Не одобрен FDA для использования в лечении гипертрофических и келоидных рубцов.

Тамоксифен

Тамоксифен конкурентно связывается с рецепторами эстрогена, создавая ядерный комплекс, который уменьшает синтез ДНК и ингибирует эффекты эстрогена.

Ретиноидоподобные агенты

Характеристика класса

Эти агенты уменьшают нормальную тонофиламентность и кератогиалиновый синтез, увеличивают продукцию мукоидного веществ, скорость роста клеток эпидермиса и ингибируют синтез ДНК в условиях invitro.

Третиноин для местного применения (ретин-A, ретин-Aмикро, ренова)

Хотя точный механизм действия неизвестен, ретиноиды уменьшают когезионную способность аномальных гиперпролиферативных кератиноцитов, модулируют дифференцировку кератиноцитов и обладают противовоспалительными свойствами. Не одобрен FDA для использования в лечении гипертрофических и келоидных рубцов.

Иммунодепрессанты

Характеристика класса

Иммунодепрессанты подавляют иммунные процессы, которые способствуют воспалению.

Такролимус в форме мази

Такролимус подавляет высвобождение цитокинов из Т-клеток. Он также ингибирует транскрипцию генов, кодирующих интерлейкин 3 (ИЛ-3), ИЛ-4, ИЛ-5, гранулоцитарно-макрофагальный колониестимулирующий фактор (ГМ-КСФ) и фактор некроза опухоли альфа (ФНО-альфа), каждый из которых участвует в ранних стадиях активации Т-клеток.

Кроме того, такролимус может ингибировать высвобождение предварительно сформированных медиаторов из тучных клеток кожи и базофилов и подавлять экспрессию высокоафинного рецептора IgE(FceRI) на клетках Лангерганса. Не одобрен FDA для использования в лечении гипертрофических и келоидных рубцов.

Местные препараты для кожи

Характеристика класса

Согласно имеющимся сообщениям, препарат имиквимод обладает некоторой эффективностью. Однако механизм действия крема имиквимод при лечении кератоза остается неизвестным.

Имиквимод - это специфический модификатор иммунного ответа. В настоящее время его применение одобрено для лечения остроконечных кондилом генитальной и перианальной области. Он способен индуцировать интерферон-альфа, ФНО-альфа, ИЛ-1, ИЛ-6 и ИЛ-8. Исследования с использованием 5% крема у мышей выявили значительную индукцию ИФН-альфа в месте применения, возникающую уже через 2 часа после лечения. Через 4 часа после нанесения было выявлено увеличение уровня ИФН-альфа мРНК, что указывает на увеличение транскрипции. Не одобрен FDA для использования в лечении гипертрофических и келоидных рубцов.

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