aknes marTva pirvelad jandacvaSi · akne da oligomenorea aReniSneba gamokvleuli unda iqnes pss-ze....

1

danarTi 1

aknes marTva pirvelad

jandacvaSi

klinikuri praqtikis erovnuli rekomendacia

(gaidlaini)

damtkicebulia saqarTvelos Sromis janmrTelobisa da socialuri dacvis ministris 2010 wlis 24 seqtembris

302o brZanebiT

miRebulia ldquoklinikuri praqtikis erovnuli rekomendaciebis (gaidlainebi) da daavadebaTa marTvis saxelmwifo

standartebis (protokolebi) SemuSavebis Sefasebisa da danergvis erovnuli sabWos

2009 wlis 30 dekembris 2 sxdomis gadawyvetilebis Sesabamisad

2

aknes marTva pirvelad jandacvaSi

1 daavadebis ganmarteba

Sesavali

akne axalgazrda asakis pirebis kanis erT-erTi yvelaze xSiri daavadebaa samedicinosTan erTad igi mniSvnelovani fsiqologiuri problemaa pacientisTvis

gaidlaini gankuTvnilia pirvelad jandacvaSi momuSave ojaxis eqimebisaTvis

aRniSnul gaidlainSi ganxilulia aknes mkurnaloba mozardebsa da mozrdilebs Soris igi ar moicavs daavadebis Sedegebis (nawiburebi anTebisSemdgomi eriTema an hiperpigmentacia) marTvis sakiTxebs

ganmarteba

akne kanis cximovani jirkvlebis anTebiTi daavadebaa qronikuli dermatozia da xasiaTdeba Ria daan daxuruli komedonebiT papulebiT pustulebiTa da kvanZovani gamonayariT

simZimis mixedviT ganarCeven daavadebis Semdeg formebs

msubuqi akne ndash komedonebi lt 20 araanTebiTi papulebi lt 15 an dazianebaTa ricxvi lt 30

saSualo simZimis Aakne ndash 15-50 papula da pustula komedonebiT iSviaTi kistebi totaluri dazianebebis ricxvi 30-125

mZime akne ndash pirveladi anTebiTi kvanZebi da kistebi aseve komedonebi papulebi da pustulebi totaluri dazianebebis ricxvi gt125

aknes dros ganviTarebuli gamonayaris tipebi

araanTebiTi

TeTri (anu daxuruli) komedonebi (araanTebiTi folikulebi romelTa Sesavali Seicavs keratinul sacobebs da dafarulia Txeli epidermuli membraniT)

Savi (anu Ria) komedonebi (araanTebiTi folikulebi romelTa Sesavali Seicavs keratinul sacobebs da Savi Seferiloba aqvs)

anTebiTi

papulebi

pustulebi

kvanZebi daan kistebi

3

2 epidemiologia

aSS-Si pirveladi jandacvis dawesebulebebis momarTvianobis 10 ukavSirdeba aknes rac warmoadgens weliwadSi 48 mln vizits1 es daavadeba mozardebis 85-s aReniSneba mozrdilebSi akne mamakacebTan SedarebiT qalebs Soris ufro xSirad gvxdeba (20-29 wlis asakSi - 43-51 30-39 wlis asakSi 20-35) pacientTa 83 gamwvavebas ukavSirebs menstrualur cikls 67 - stress 26 - kvebas2

sxvadasxva monacemebiT saqarTvelos 12-25 wlamde mosaxleobis 80-s aqvs aknes gamovlineba

prognozi

akne TandaTan gaivlis sicocxlis mesame dekadaSi (dehidroepiandrosteronis donis TandaTan Semcirebis gamo) Tumca SesaZlebelia mozrdilobis periodSi misi persistireba an de novo ganviTareba mozrdilTa akne upiratesad qalebs Soris aRiniSneba (pubertuli periodis daavadebisagan gansxvavebiT romelic ufro xSirad biWebs Soris gvxvdeba6) aknes premenstrualuri gamwvavebebi upiratesad ufrosi asakis qalebs Soris vlindeba

3 etiopaTogenezi

akne kanis cximovani folikulebis daavadebaa mis ganviTarebaSi

Semdegi oTxi faqtori monawileobs

retenciuli hiperkeratozi

cximis gaZlierebuli produqcia

dazianebuli aris kolonizacia baqteriebiT (Propionibacterium acne)

anTebiTi procesi

cximovan jirkvalSi cvlilebebi hiperkeratoziT iwyeba igi vlindeba folikulis Sesavalis keratinocitebis gaZlierebuli proliferaciiT da deskvamaciis SeferxebiT Sedegad jirkvlis arxSi yalibdeba sacobi romelic cximisa da keratinisgan Sedgeba (mikrokomedonebi)

sqesobrivi momwifebis periodSi cximovani jirkvlebi diddeba da cximis produqciac Zlierdeba mikrokomedonebi qmnian anaerobul cximiT mdidar garemos igi kargi niadagia baqteriebis zrdisTvis romlebic kvebis wyarod trigliceridebs iyeneben da Slian maT hidrolizis gziT cximovan mJavebad da glicerinad baqteriebi ZiriTadad warmodgenilia Propionibacterium acne-Ti (P acne) romelic kanis

normaluri floris Semadgeneli komponentia

mikroorganizmebi (P acne da aseve sxva kokebi) aTavisufleben qemoatraqtantebs romlebic infeqciis areSi neitrofilebs moizidavs3

Tavisufali cximovani mJavebi da lizosomuri fermentebi (gamoTavisufldeba neotrofilebis mier) folikulis epiTelis dazianebas (rupturas) iwvevs ris gamoc keratini da lipidebi

4

CaiRvreba irgvlivmdebare dermaSi da warmoiqmneba papulebi an kvanZebi

folikulis hiperkeratozis xarisxis cximis produqciis mikroorganizmis zrdis da anTebis mixedviT mikrokomedonebi iyofa araanTebiTad (Ria da daxuruli komedonebi) da anTebiTad (pustulebi papulebi an kvanZebi)

cximis dagrovebis Sedegad mikrokomedonebi daxurul (TeTr) komedonebad gadaiqceva

folikulis SesarTavi TandaTan ixsneba (gaWimvis gamo) da Ria (Savi) komedonebi yalibdeba maT muq Seferilobas Calagebuli keratinocitebi daJanguli cximebi da melanini aniWebs

anTebiTi dazianeba (kistebi) folikulis SigTavsis garemomcvel dermaSi CaRvris Sedegad viTardeba yalibdeba zedapiruli pustulebi Rrma papulebi an kidev ufro Rrma kistebi (rupturis donidan gamomdinare)

aknes mqone pacientebis umravlesobas androgenebis hiperproduqcia ar aReniSneba am dros cximovani jirkvlebis mgrZnobeloba androgenebisadmi momatebulia (hipersensitiuloba) Tumca androgenebis siWarbem (sxvadasxva daavadebebis dros) SeiZleba aknes ganviTareba gamoiwvios

aknes mqone prepubertuli asakis gogonebis sisxlSi nanaxia dehidroepiandrosteronis (dhea) sulfatis ufro maRali done vidre daavadebis armqoneTa Soris4 aRniSnuli hormonis maRali maCvenebelis dros mZime akne viTardeba5

daavadebis ganviTarebis xelSemwyobi faqtorebi

daavadebis ganviTarebaSi mniSvnelovani roli eniWeba genetikur faqtors

garemo faqtorebi kosmetikuri saSualebebis gamoyenebam SeiZleba xeli Seuwyos aknes ganviTarebas zeTovani cximovani komponentebi da saRebavebis Semcveloba am saSualebebSi iwvevs kanis dazianebis gamwvavebas xolo wyalze damzadebuli ndash naklebad komedogenuria8

sapnebi sxvadasxva detergentebi da Semkvrelebi iwveven cximis mocilebas kanis zedapiridan magram cximis produqciaze gavlenas ar axdenen daavadebas auaresebs9 ganmeorebiTi meqanikuri travma (uxeSi jagrisis gamoyenebis Sedegad) amgvari gziT kanis maceraciis Sedegad ew meqanikuri aknes (acne mechanica) ganviTareba SeiZleba gamoiwvios perangis sayelom samxreebma sportuli Cafxutis tarebam da a S Sesabamisad pacientebi unda moeridon mWidro tansacmlis tarebas da Tavi Seikavon saxis kanis travmirebisgan (gaxexva da aS)

aseve amwvavebs daavadebas tenianoba da Zlieri ofli qlorakne gamowveulia halogenirebuli hidrokarbonatebis dioqsinis zemoqmedebis Sedegad (kanTan kontaqtis inhalaciis an organizmSi moxvedris gziT) aRniSnuli qimiuri nivTierebebi gvxvdeba sawarmoo

5

produqtebSi dabinZurebul sakvebSi da aS klinikurad qlorakne farTo monomorfuli komedonebiT xasiaTdeba romelic mZime anTebad dazianebebad transformirdeba da nawiburebs warmoqmnis

dieta aknes ganviTarebaSi kvebiTi faqtorebis mniSvnelobis Sesaxeb urTierTsawinaaRmdego monacemebi arsebobs101112 sakmarisi mtkicebulebebi ara arsebobs raimes akrZalvisTvis erT-erTi kvlevis Sedegad gamovlinda kavSiri aknes ganviTarebasa da rZis miRebas Soris13 avtorebis mosazrebiT daavadebis gamwvavebas rZis hormonuli komponentebi daan sxva bioaqtiuri molekulebi iwvevs sxva kvlevebiT aknes ganviTareba SeiZleba insulinismagvarma zrdis faqtorma gamoiwvios

pica Txili tkbileuli Sokoladi aknes mizezs ar warmoadgens14

stresi stresi iwvevs daavadebis gamwvavebas1516 prospeqtuli

kohortuli kvlevis mixedviT romelSic 94 saSualo skolis moswavles ikvlevdnen dardeboda aknes simZime da kanis mier cximis producireba Zlieri (Sualeduri gamocdebi) da msubuqi stresis dros (sazafxulo ardadagebi)17 kanis mier cximis producireba ar iyo dakavSirebuli xolo aknes simZime kavSirSi iyo stresTan gansakuTrebiT vaJebs Soris aRniSnuli kvlevis msgavsad 22 umaRlesi saswavleblis studentis multivariantulma analizma gamoavlina aknes simZimis korelacia stresTan (mag gamocdebis periodSi)18

4 klinikuri simptomatika

akne viTardeba tipur agdilebze ndash sxeulis im nawilebze sadac kani didi raodenobiT Seicavs cximovan jirkvlebs esenia saxe kiseri gulmkerdi zurgis zeda nawili mxrebi

aknesTvis damaxasiaTebel dazianebasTan (TeTrTaviani SavTaviani komedonebi da anTebiTi kerebi) erTad aRiniSneba nawiburebi da hiperpigmentacia hiperpigmentacia ufro metad vlindeba muqi feris kanis mqoneTa Soris

5 daavadebis diagnozi

pacientis Sefaseba anamnezis detalurad SegrovebiT iwyeba daavadebis diagnozi kanis daTvalierebiT ismeba

fizikuri gasinjvisas ganisazRvreba dazianebebis lokalizacia tipi (anTebiTi araanTebiTi) zoma (mcire lt5 mm ndash papulebi an pustulebi didi zomis gt5 mm ndash kvanZebi) daavadebis Sedegebi nawiburebi (atrofiuli gavrcelebuli hipertrofuli keloidi) hiperpigmentacia anTebisSemdgomi eriTema

kvlevebis Catareba Cveulebriv saWiro ara aris maTi Catarebis saWiroeba sxva Tanmxlebi niSnebis arsebobis SemTxvevaSi dgeba (mag

6

hirsutizmi an virilizaciis arseboba Semdgom laboratoriuli da gamosaxulebiTi kvlevebs saWiroebs)

ganxiluli unda iqnes endokrinuli daavadebebis SesaZlo arsebobac magaliTad qalebs Soris polikisturi sakvercxeebis sindromi (pss) hiperandrogenizmis erT-erTi mizezia es sindromi menstrualuri funqciis darRveviT hirsutizmiT aknes ganviTarebiT sakvercxis kistebiT sxvadasxva xarisxis insulinisadmi rezistentobiT da Savi akanToziT xasiaTdeba erT-erTi kvlevis mixedviT 51 aknes mqone qals Soris 39 hqonda menstrualuri ciklis darRveva da 37-s pss19 aRniSnuli dakvirvebis Sedegebi mowmobs rom yvela qalis romelsac akne da oligomenorea aReniSneba gamokvleuli unda iqnes pss-ze

aknes swrafi ganviTareba virilizaciasTan erTad Tirkmelzeda an sakvercxis simsivnisaTvisaa damaxasiaTebeli aseve akne uviTardebaT pacientebs kuSingis daavadebis an sindromis mqoneT an adrenerguli hiperplaziis dros virilizaciis simtomebs miekuTvneba xmis Secvla sarZeve jirkvlebis zomaSi Semcireba klitoromegalia alopecia oligomenorea da hirsutiazmi aseT pacientebs Tirkmelzeda jirkvlebis da sakvercxeebis radiologiuri da hormonuli kvlevebis Catareba esaWiroebaT

anamnezis Segrovebisas yuradReba unda gamaxvildes sxvadasxva samkurnalo saSualebebis miRebaze aknes ganviTarebis mizezi SesaZloa iyos iseTi samkurnalo saSualebebis xangrZlivad moxmareba rogoricaa adenokortikotropuli hormoni androgenebi azaTiopreni barbituratebi bromidebi kortikosteroidebi ciklosporini disulfirami halogenebi iodidebi izoniazidi liTiumi feniTioni vitaminebi B2 B6 da B12

20

gamokvlevebis gegma

mikrobiologiuri kvleva rutinulad ar tardeba (rekomendacia II

B) mikrobiologiuri kvlevis Catareba esaWiroebaT pacientebs romelTac aqvT aknesmagvari gram-uaryofiTi floriT gamowveuli folikuliti

androgenebis donis gansazRvra sisxlSi rutinulad ar tardeba (rekomendacia I A) kvlevis Catareba marTebulia rodesac pacients aknesTan erTad androgenebis siWarbis sxva niSnebic aqvs bavSvebSi igi SeiZleba gamovlindes Tmianobis matebiT iRliaSi an boqvenze klitoromegaliiT mozrdil qalebSi ndash menstrualuri ciklis gaiSviaTebiT hirsutizmiT alopeciiT unayofobiT Savi akanToziT simsuqniT da aS

cxrili 1 rekomendacia mikrobiologiuri testirebis Casatareblad

rekomendacia rekomendaciis

xarisxi

mtkicebulebis

done literatura

mikrobiologiuri testireba B II 21-24

7

6 mkurnaloba

mkurnalobis mizania pacientis zogadi mdgomareobis gaumjobeseba gamonayaris kontroli diskomfortis da fsiqosocialuri stresis Semcireba nawiburebis prevencia

aknes samkurnalod mowodebulia rigi adgilobrivi da sistemuri saSualebebi (ix cxrili 5) maTi arCevani damokidebulia klinikurad gamovlenili dazianebis tipsa da simZimeze25 (ix sqema 1 2 3) mikrokomedonebis maturacia 8 kviramde grZeldeba da aqedan gamomdinare efeqtis misaRebd mkurnalobis xangrZlivoba am periodze naklebi ar unda iyos

mkurnaloba diagnostikis Semdgom rac SeiZleba male unda daiwyos da yovel 2-3 TveSi Sefasdes da gadaixedos iSviaTad Tumca aRwerilia SemTxvevebi roca mkurnaloba ramodenime wels gagrelda26

istoriuli mimoxilva Zveli egviptisa da saberZneTis istoriul ZeglebSi mocemulia informacia kanis daavadebis Sesaxeb romelsac axla aknes vuwodebT antikur romSi aknes mkurnalobdnen cxel mineralur an gogirdis abazanebiT 1800 wels dermatologebma oficialurad aRiares gogirdi rogorc aknes samkurnalo saSualeba 1920 wlidan ki farTo gamoyeneba hpova benzoil peroqsidma 1930 wlidan am mimarTulebiT gamoiyeneboda safaRaraTo saSualebebi da radiaqtiuli nivTierebebi 1950 wlidan farTod daiwyes antibiotokebis gamoyeneba amave droidan gamoixata tetraciklinis jgufis antibiotikebis upiratesi efeqti anTebiTi aknes mkurnalobisTvis mogvianebiT Sesabamisi farmakologiuri formebis SemuSavebis Semdgom dainerga adgilobrivi antibiotikebis gamoyeneba 1970 wels moxmarebaSi Semovida tretinoini M

mkurnalobis saxe (adgilorivi sistemuri) daavadebis simZimiTa da dazianebis lokalizaciiT ganisazRvreba

medikamentebi adgilobrivi mkurnalobisaTvis

mkurnalobisTvis adgilobrivi (lokaluri) saSualebis saxeobis arCeva pacientis kanis tipis da survilis gaTvaliswinebiT xdeba geli iwvevs kanis gamoSrobas amitom misi gamoyeneba umjobesia cximiani kanis SemTxvevaSi malamo da losionebi kans anotiveben da upiratesoba maT mSrali kanis SemTxvevaSi eniWebaT adgilobrivi saSualebebis umetesoba dReSi orjeradad gamoiyeneba Tumca SesaZlebelia dReSi erTjeradi an dRegamoSvebiT gamoyeneba Tu xSiri moxmarebisas kanis gaRizianeba viTardeba amasTan ufro efeqturia adgilobrivi saSualebebis kombinacia vidre maTi damoukideblad calk-calke gamoyeneba miRebuli kombinaciebia retinoidebi benzoil peroqsidi da topikuri antibiotikebi

kombinacia iZleva ufro gamoxatul Terapiul efeqts vidre TiToeuli agentis damoukidebeli gamoyeneba

erTze meti adgilobrivi saSualebis gamoyenebisas ndash erTi gamoiyeneba diliT meore ndash saRamos rogorc wesi adgilobrivi retinoidebi saRamos iniSneba

8

benzoilis zeJangi

benzoilis zeJangi gamoiyeneba sxvadasxva koncentraciiTa da SemavsebeliT am etapze ar arsebobs mtkicebuleba romelic sxvadasxva formulebis upiratesobas gansazRvravs msoflios bevr qveyanaSi gaicema ureceptod xasiaTdeba baqtericiduli moqmedebiT ainhibirebs axali komedonebis warmoqmnas amcirebs folikulur lipidebsa da Tavisufal cximovan mJavebs rac Tavis mxriv epiTelis deskvamacias iwvevs arCevis preparatia mkurnalobis dawyebisas da nebismieri simZimis aknes dros gamoiyeneba xsnarebi da malamoebi gelTan SedarebiT naklebad iwveven kanis iritacias Tumca mainc SeiZleba gamoiwvion eriTema aqercvla da iSviaTad ndash kontaqturi reaqcia27 gamoiyeneba dReSi 2-jer adgilobriv retinoidebTan kombinaciaSi gamoyenebisas kanis gaRizianebisa da fotoreaqciis Tavidan acilebis mizniT benzoilis zeJangi diliT xolo retinoidebi saRamos iniSneba benzoilis zeJangisa da retinoidebis (adapaleni-retinoidebis sinTezuri analogi tretinoini) erTdrouli gamoyeneba ufro efeqturia vidre TiToeuli agentisa calk-calke2829

adgilobrivi retinoidebi

adgilobrivi retinoidebi Tavisi qimiuri formuliT enaTesavebian A

vitamins maTi efeqturoba aknes mkurnalobaSi araerTi mtkicebulebiTaa dadasturebuli34-50 isini erTaderTi saSualebebia romlebic folikuluri epiTelis terminaluri diferenciaciaze axdens gavlenas da arCevis preparatebia araanTebiTi aknes mkurnalobisTvis amasTan gamoiyenebian anTebiTi aknes samkurnalodac retinoidebi axdenen obstruqciis Semcirebas folikulSi keratinizaciis procesis normalizebis gziT aferxeben komedonebis progresirebas anTebad dazianebamde aumjobeseben komedonebis drenaJs aferxeben axali komedonebis warmoqmnas5152 rigi SedarebiTi kvlevebiT ar gamovlinda romelime retinoidis upiratesoba meoresTan SedarebiT

erTerTi kvleviT tazarotenis geli ufro efeqturi aRmoCnda tretinoinis gelTan SedarebiT (araanTebiTi da anTebiTi dazianebebis Semcireba)53 Tumca sxva kvleviT dRegamoSvebiT tazaroteniT mkurnaloba iseTive efeqturi iyo rogorc adapaleniT yoveldRiuri mkurnaloba54 eriTema wva qavili tretinoinTan da adapalenTan SedarebiT ufro gamoxatuli iyo tazarotenis gelis SemTxvevaSi gverdiTi efeqtebi mcirdeba tazarotenis malamos gamoyenebisas Tumca SedarebiTi kvlevebi am agentisa da sxva adgilobrivi retinoidebiT ar Catarebula

sxva kvleviT adapaleni (01 geli) ufro efeqturi aRmoCnda tretinoinTan SedarebiT (0025 geli)55

gverdiTi efeqtebis Semcireba SeiZleba dabali koncentraciis (0025) saSualebebis gamoyenebiT da amtanobis SemTxvevaSi koncentraciis TandaTan gazrdiT (0025 malamo Semdeg 001 geli 005 kremi 0025 geli 01 kremi 005 xsnari) yvela retinoids gaaCnia kanis gamaRizianebeli moqmedeba SeiZleba gamoiwvion kanis siwiTle

9

gaRizianeba damwvroba zrdian fotosensitiurobas amitom maTi gamoyeneba unda moxdes saRamos xolo dRis ganmavlobaSi mzisagan damcav saSualebebTan (kremebTan) erTad mkurnalobis dasawyisSi SesaZloa mdgomareobis gauareseba ukunaCvenebia orsulobis dros

cxrili 2 rekomendaciebi adgilobrivi mkurnalobisaTvis


xarisxi

mtkicebulebis

done literatura

benzoilis zeJangi A I 30-33

retinoidebi A I 34374750

antibiotikebi A I 61-69

sxva adgilobrivi saSualebebi A I 70-77

adgilobrivi antibiotikebi

adgilobrivi antibiotikebis damateba P acne-s cximovani folikulidan eliminaciis mizniT xdeba anTebiTi da papuluri aknes mkurnalobis dros adgilobrivi eriTromicini gamoiyeneba dReSi erTxel an orjer adgilobrivi 1-iani klindamicini gamoiyeneba RamiT an dReSi orjer

aRsaniSnavia rom adgilobrivi antibiotikebis gamoyenebam SesaZloa xeli Seuwyos P acne-s rezistentuli Stamebis gaCenas rezistentoba mcirdeba adgilobrivi antibiotikebis sxva saSualebebTan kombinaciaSi daniSvnisas amasTan kombinirebuli mkurnaloba ufro efeqturia vidre am saSualebebis calk-calke gamoyeneba

56-59 magaliTad erTerTi kvleviT gamovlinda rom 3-iani eriTromicinis da benzoilis zeJngis 5-iani geliT kombinirebuli mkurnaloba ara marto aRemateboda efeqturobiT TiToeul agents calk-calke aramed gaumjobesebas iZleoda rezistentuli Stamebis SemTxvevaSic60 aseve klindamicinibenzoilis zeJangis geliT mkurnaloba efeqturi iyo TiToeul agentTan SedarebiT59 sxva kvleviT klindamicini da adapalenis kombinacia ufro efeqturi iyo mxolod klindamicinTan SedarebiT Tumca kanismxrivi gverdiTi efeqtebi (aqercvla simSrale wva) ramdenadme gauaresda kombinirebuli mkurnalobis dros

sxva adgilobrivi saSualebebi

salicilis mJava - istoriulad erTerTi Zveli agentia romelic aknes mkurnalobisTvis gamoiyeneboda Tumca retinoidebTan SedarebiT misi komedolizuri moqmedeba ufro sustia is warmoadgens retinoidebis alternativas rodesac pacientebs aReniSnebaT autanloba retinoidebis mimarT rac kanis iritaciiT vindeba70

azelainis mJava (II) ndash aqvs antikomedonuri da antibaqteriuli Tvisebebi amitom gamoiyeneba rogorc anTebiTi aseve araanTebiTi aknes dros rigi klinikuri kvlevebiT nanaxia misi efeqturoba71-73 amcirebs

10

kanis pigmentacias da ufro efeqturia misi gamoyeneba aknesTan asocirebuli hiperpigmentaciis dros74

aluminis qlorids antibaqteriuli moqmedeba gaaCnia Tumca kvlevebma gansxvavebuli Sedegebi aCvena ndash erT SemTxvevaSi misi efeqturoba gamovlinda75 meoreSi76 ndash ara

sistemuri mkurnaloba

sistemuri antibiotikebi

sistemuri antibiotikebi anTebiTi aknes mkurnalobisaTvis gamoiyeneba ainhibireben P acnes zrdas folikulSi sistemuri antibiotikoTerapia adgilobriv saSualebebTan SedarebiT ufro swraf klinikur gaumjobesebas iZleva Tumca SesaZlebelia antibiotikebis gverdiTi efeqtebis gamovlineba rogoricaa vaginaluri kandidozi gastrointestinuli darRvevebi da aS es saSualebebi iniSneba yoveldRiurad 4-6 Tvis manZilze mdgomareobis gaumjobesebisas TandaTan xdeba dozis Semcireba da Sewyveta maTi Sewyvetis Semdeg mgomareobis SenarCuneba SesaZlebelia adgilobrivi retinoidebis an

benzoilis zeJangis saSualebiT77-79

sistemuri mkurnalobisaTvis gamoiyeneba tetraciklini doqsiciklini minociklini eriTromicini trimetoprim-sulfameToqsazoli da klindamicini

tetraciklins (I A) upiratesoba eniWeba dabali fasis da kvlevebiT dadasturebuli maRali efeqturobis gamo mkurnaloba iwyeba doziT 500 mg orjer dReSi Tumca 250 mg 2-jer ndash SesaZloa aseve efeqturi iyos absorbcias amcirebs sakvebi rZis produqtebi antacidebi rkina iniSneba uzmoze misaRebad ukunaCvenebia orsulobis dros da 12 wlis asakamde vinaidan iwvevs kbilis minanqaris feris Secvlas

doqsiciklini (I) da minocilkini (B) tetraciklinTan SedarebiT ufro metad xsnadia cximSi da gamoiyeneba ufro mcire dozebiTac (100 mg 2-jer an 50 mg 2-jer) am saSualebebis miReba sakvebTan erTadac SeiZleba vinaidan sakvebi ar amcirebs mis absorbcias minociklini arCevis pirveli rigis preparati araa maRali fasisa da tetraciklinTan SedarebiT metad efeqturobis Sesaxeb zusti monacemebis ararsebobis8182 agreTve toqsikurobis gamo8384 doqsiciklini da minocilkini iniSneba tetracikliniT mkurnalobis araefeqturobis SemTxvevaSi doqsiciklini iwvevs fotosensibilizacias saylapavis wylulis ganviTarebis Tavidan acilebis mizniT sakmao odenobis wyalTan erTad unda iqnes miRebuli

SesaZloa gamoiwvios Tavbruxveva pseudotumor cerebri kbilebis feris cvlileba mgluras magvari sindromi85-87 sifrTxiliT unda iqnes gamoyenebuli mgluras mqone pacientebs Soris aknes mkurnalobis mizniT

eriTromicini SesaZlebelia dainiSnos 250-1500 mg dRiuri doziT (or miRebad) misi anTebis sawinaaRmdego moqmedeba tetraciklinTan

11

SedarebiT mcirea amasTan xSirad viTardeba rezistentuli Stamebi88 da gastrointestinuri gverdiTi efeqtebi eriTromicini arCevis saSualebaa im SemTxvevebSi roca SezRudulia tetraciklinis daniSvna (orsuli 8 wlamde bavSvi) mimdinareobs kvleva azitromicinis efeqturobis Sesaxeb maqsimaluri doza 60 g 10 kviris ganmavlobaSi89

trimetoprim-sulfameToqsazoli arCevis meore rigis preparatia (40080mg erTjer an orjer dReSi) efeqturi saSualebaa mZime aknes mkurnalobisaTvis Tumca misi gamoyeneba SezRudulia iseTi seriozuli gverdiTi efeqtebis gamo rogoricaa Zvlis tvinis supresia da toqsikuri epidermuli nekrozi amis msgavsad SezRudulia oraluri klindamicinis gamoyeneba fsevdomembranozuli kolitis ganviTarebis riskis gamo

aknes mqone pacientebis mkurnalobis procesSi seriozul problemas warmoadgens mikrobTa rezistentoba misi xelSemwyobia antibiotikebis farTod gamoyeneba da maTi monacvleoba SedarebiT xSiria rezistentobis ganviTareba eriTromicinis xolo iSviaTi ndash minociklinis mimarT antibiotikoTerapiam SesaZloa xeli Seuwyos Streptococcus pyogenes-is rezistentuli StamebiT xaxis kolonizacias90 rezistentobis problema SeiZleba Semcirdes Semdegi gziT

antibiotikis daniSvna misi absoluturi saWiroebis SemTxvevaSi SeZlebisdagvarad xanmokle mkunalobis kursi (Tumca aranakleb 3 Tvisa) SesaZleblobis mixedviT adgilobrivi saSualebebis

gamoyeneba

benzoilis zeJangis gamoyenebam SeiZleba Seamciros rezistentobis sixSire

oraluri saSualebebis Sewyvetis Semdeg Tu dgeba misi ganaxlebis saWiroeba umjobesia isev imave antibiotikis daniSvna manam sanam igi efeqturi darCeba

cxrili 3 rekomendaciebi sistemuri antibiotikoTerapiisaTvis


xarisxi

mtkicebulebis

done literatura

tetraciklinebi A I 91-94

makrolidebi A I 95-98

trimetoprim-sulfameToqsazoli A I 99100

12

sistemuri retinoidebi

sistemuri retinoidebi mZime formis aknes mkurnalobisaTvis gamoiyeneba aseve SeiZleba misi gamoyeneba naklebad mZime magram mkurnalobisadmi rezistuli formis dros nawiburovani aknes an daavadebasTan dakavSirebuli Zlieri fsiqo-socialuri stresis SemTvevaSi amcirebs cximis sekrecias misi efeqti samkurnalo saSualebis miRebis Sewyvetidan 1 wlamde grZeldeba cximis Semcireba Tavis mxriv iwvevs proliferaciis Semcirebas samkurnalo saSualebas anTebis sawinaaRmdego moqmedebac gaaCnia da komedonebis warmoqmnas aferxebs101

sistemuri izotretinoinis daniSvnis Cvenebebia

mZime kvanZovan-cisturi akne

akne romelic mxolod mcired gaumjobesda sistemuri antibiotikoTerapiis 6 Tviani kursis Semdeg

nawiburovani akne

akneTi gamowveuli mZime stresi

ganmeorebiTi akne

fulminanturi akne

gram-uaryofiTi folikuliti

mkurnaloba iwyeba 05 mgkg dRiuri doziT da SeiZleba 2 mgkg dozamde gaizardos iniSneba 2 miRebad sakvebTan erTad Cveulebriv mkurnalobis xangrZlivoba 20 kviramdea arsebobs mtkicebulebebi rom efeqturi SeiZleba iyos ufro dabali dozebiT mkurnalobac102 mkurnalobis dawyebisas SesaZloa aknes gauareseba aseT SemTxvevebSi naCvenebia sistemuri kortikosteroidebis daniSvna an mkurnalobis ufro dabali dozebiT (05 mgkgdR-ze naklebi) dawyeba mkurnalobis kumulaciuri doza 120-150 mgkg-ia

pacientebis 80-ze mets mkurnalobis erTi kursis Semdeg xangrZlivi remisia aReniSneba gaumjobeseba mkurnalobis Sewyvetidan ramdenime Tve grZeldeba saWiroebisas kursis ganaxlebamde 4-5 Tve unda iyos gasuli recidivebis umetesoba (96) mkurnalobis Sewyvetidan pirveli 3 Tvis ganmavlobaSi aRmocendeba103 da misi sixSire gansakuTrebiT maRalia pacientebs Soris romelTac akne upiratesad torsze aReniSnebaT an samkurnalo saSualebis kumulaciuri doza 120 mgkg-ze naklebia

izotretinoinis kursis Semdeg remisiis maRali sixSiris miuxedavad pacientebis mxolod 39-s aReniSneba sruli gamojanmrTeleba 61-s ki kvlav esaWiroeba adgilobrivi an sistemuri antibiotikebiT mkurnalobis gagrZeleba104 izotretinoinis maRali Rirebulebis miuxedavad am saSualebiT Catarebuli mkurnaloba mainc xarjTefeqturad SeiZleba CaiTvalos vinaidan es erTaderTi saSualebaa romelic aknes ganviTarebis meqanizmze moqmedebs Tumca aRsaniSnavia isic rom izotretinoinTan dakavSirebulia sakmaod seriozuli da mZime gverdiTi efeqtebi rac zRudavs mis gamoyenebas

13

igi sakmaod Zlieri teratogenia sxva gverdiT efeqtebs miekuTvneba kankunTovani ConCxovani Tvalis cns-is mxrivi efeqtebi aseve Tavis tkivili aRniSnuli gverdiTi efeqtebi droebiTia da mkurnalobis SewyvetasTan erTad gaivlis erTeul SemTxvevebSi aRwerilia guneba-ganwyobis cvlileba suiciduri ideebi da suicidi aqedan gamomdinare aRniSnuli saSualeba daniSneuli unda iqnes saTanado kompetenciis mqone eqimis mier

cxrili 4 izotretinoiniT mkurnalobasTan dakavSirebuli rekomendaciebi

rekomendacia rekomendaciis xarisxi

mtkicebulebis done

literatura

izotretinoini A I 108-116

izotretinoinis gverdiTi efeqtebis umetesobis marTva (mag damarbilebeli saSualebebi mSrali kanisTvis aass-ebi mialgiis an arTalgiis sakvebi racionis cvlileba lipidur speqtrSi cvlilebebis dros) mkurnalobis Sewyvetis gareSec aris SesaZlebeli

14

cxrili 5 adgilobrivi da sistemuri saSualebebi

samkurnalo

saSualeba dozireba

gamoSvebis

forma gverdiTi movlenebi


tretinoini

(Tretinoin)

Cveulebriv dReSi orjer (SeiZleba yoveldRiuri an autanlobis SemTxvevaSi dRegamoSvebiT gamoyeneba)

0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari

adgilobrivi iritacia fotosensitiuroba

adapaleni

(Adapalene)

yoveldRiurad an dReSi orjer

01 geli adgilobrivi iritacia (tretinoinTan SedarebiT naklebad) fotosensitiuroba

tazaroteni

(Tazarotene) yoveldRiurad

005 geli

01 geli

adgilobrivi iritacia (tretinoinTan SedarebiT naklebad) fotosensitiuroba ukunaCvenebia orsulobis da ZuZuTi kvebis dros

benzoilis

zeJangi (Benzoyl

peroxide)


25 5 da 10 geli losioni

5 xsnari + 3 eriTromicini

6 da 10 geli + glikolis mJava

adgilobrivi iritacia SeiZleba gamoiwvios kanisa da tansacmlis gauferuleba


metronidazoli

(Metronidazole) dReSi orjer

1 kremi

075 geli

15

klindamicini

(Clindamycin) dReSi orjer

10 mgml geli

10mgml losioni

10 mgmL adgilobrivad saxmari xsnari

Teoriulad - fsevdomembranozuli koliti

eriTromicini

(Erythromycin) dReSi orjer

15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava

(Azelaic acid) dReSi orjer 20 kremi

oraluri antibiotikebi

tetraciklini

(Tetracycline)

500 mg orjer dReSi (an 250 mg orjer dReSi)

ukunaCvenebia orsulobis da 12 wlis asakamde radgan SesaZlebelia gamoiwvios kbilebis feris Secvla

doqsiciklini

(Doxycycline) 100 mg orjer dReSi fototoqsikuroba saylapavis dawyluleba

minociklini

(Minocycline)

50 dan 100 mg-mde orjer dReSi

vertigo pseudotumor kbilebis feris cvlileba

eriTromicini

(Erythromycin)


gastrointestinuri Civilebi

oraluri retinoidi

izotretinoini

(Isotretinoin)

05 mgkg izrdeba 1 mgkg-mde saerTo doza 120 dan 150 mgkg-mde aranakleb 20 kviris manZilze

teratogenoba (absoloturad ukunaCvenebia orsulobisa da ZuZuTi kvebis dros) kan-kunTovani gverdiTi efeqtebi hipertrigliceridemia depresia Zvlis tvinis supresia sxva (ix teqstSi)

aRniSnuli saSualebebi saqarTveloSi registrirebuli ar aris

16

sxva mkurnaloba

kombinirebuli oraluri kontraceptivebiT mkurnaloba (estrogeni progestini) alternatiuli meTodia qalebisTvis romelTvisac klasikuri mkurnaloba arasakmarisia oraluri kontraceptivebi gamoiyeneba maTi antiandrogenuli efeqtis gamo estrogenuli komponenti amcirebs androgenebis produqcias Tavisufal testosteronsMmarto progestinis Semcveli kontraceptivebi araefeqturia SesaZloa maTi gamoyenebis fonze mdgomareobis gauaresebaAaseve ar arsebobs kvleva romelic sxva saxis kontraceptivebis efeqturobas adasturebs pasuxi mkurnalobaze 3-6 Tvis Semdgom miiReba araerTi kvleva adasturebs insulinorezistentobisa da aknes korelacias Sesabamisad metformini am SemTxvevaSi arCevis pirveli rigis preparatia Sedegi Zlierdeba metforminisa da oraluri kontraceptivebis kombinirebuli gamoyenebisas117

spironolaqtoni ndash misi antiandrogenuli efeqtis gamo gamoiyeneba qalebSi rodesac mkurnalobis sxva saxe araefeqturia axdens testosteronis mier cximovani jirkvlebisa da Tmis folikulebis stimulaciis SeCerebas Ooptimaluri doza 50-200mg pasuxi mkurnalobaze mosalodnelia 2-3 TveSi Aar gamoiyereba orsulebSi fertiluri asakis qalebSi misi gamoyenebisas rekomendebulia orsulobisagan Tavis Sekaveba gverdiTi efeqtebi iSviaTia SesaZloa araregularuli menstruacia Tavis tkivili dispepsia spironolaqtoni kaliumis Semnaxveli Sarmdenia Sesabamisad SesaZloa kaliumis donis mateba rekomendebulia eleqtrolitebis donis monitoringi dasaSvebia xangrZlivi gamoyeneba (1-2 weli) mokle SesvenebebiT122

flutamidi arasteroiduli antiandrogenia ZiriTadad prostatis hipertrofiisa da hirsutizmis samkurnalod gamoiyeneba efeqturia aknes mkurnalobaSi mis gamoyenebas zRudavs RviZlis ukmarisobis ganviTarebis maRali riski

cxrili 6 hormonul mkurnalobasTan dakavSirebuli rekomendaciebi


xarisxi

mtkicebulebis

done

literatura

kontraceptivebi A I 118-121

spironolaqtoni B II 123

antianrogenebi B II 124 125

oraluri kortikosteroidebi B II 126

17

oraluri kortikosteroidebi gamoiyeneba ori mizeziT antianTebiTi efeqti da adrenaluri aqtivobis supresia maRali doziT xanmokle kursi rekomendebulia Zlier gamoxatuli anTebiTi dazianebebis dros

kvlevebi adasturebs rom aknes mqone pacientebs TuTiis normaze naklebi Semcveloba aqvT Tumca es faqti ar aris TuTiis Semcveli medikamentebis an biodanamatebis daniSvnis Cveneba ramodenime ormagi brma-randomizebuli kvleviT dadasturebulia rom TuTia ufro efeqturia vidre placebo magram naklebefeqturia antibiotikebTan SedarebiT amave dros sainteresoa is faqtic rom yvela kvlevaSi romelic sustad magram mainc adasturebs TuTiis dadebiT efeqts igi gamoyenebuli iqna doziT romelic DdRiur moTxovnas aRemateba da SesaZloa toqsikuri iyos127128129

aknes mkurnaloba simZimis mixedviT (algoriTmebi)

sqema 1 msubuqi aknes mkurnalobis algoriTmi

mkurnalobis gagrZeleba dazianebis srul

aRmofxvramde da Semdgom dozirebis Semcireba an mkurnalobis Sewyveta

saSualo simZimis aknes

mkurnaloba ix Sesabamisi algoriTmi

sqema 2

arCevis saSualebaa adgilobrivi retinoidebi

aseve SesaZlebelia benzoilis zeJangi azelainis

mJava an salicilis mJava

pasuxi mkurnalobaze

3 Tviani mkurnaloba uSedegoa

upiratesad komedonebi iSviaTi anTebiTi papulebi an pustulebi

nawiburebi ar vlindeba

18

sqema 2 saSualo simZimis aknes mkurnalobis algoriTmi



mZime aknes mkurnaloba ix Sesabamisi

algoriTmi sqema 3

referalis saWiroebis

gansazRvra


+

benzoilis zeJangi adgilobrivi antibiotikebi

an azelainis mJava

pasuxi mkurnalobaze


komedonebi da didi raodenobiT papulebi da pustulebi

(upiratesad saxeze) vlindeba nawiburebi

19

sqema 3 mZime aknes mkurnalobis algoriTmi

oraluri antibiotikebi iniSneba yoveldRiurad

4-6 Tvis manZilze gaumjobesebis

SemTxvevaSi dozis TandaTan Semcireba da mkurnalobis Sewyveta

sxva saSualebebis dozirebis Semcireba an mkurnalobis Sewyveta

referali

oraluri kontraceptivebi an antiandrogenebi

(mxolod qalebs Soris)

pasuxi mkurnalobaze


didi raodenobiT komedonebi papulebi da pustulebi saxeze kiserze da torsze gamoxatuli

nawiburebi


+ benzoilis zeJangi

+ adgilobrivi antibiotikebi

oraluri izotretinoini (araorsulebSi)


+ adgilobrivi retinoidebi

benzoilis zeJangi an azelainis mJava

an

araadekvaturi pasuxi mkurnalobaze

20

7 referali

referalis Cveneba mudmivi kamaTis sagania sadReisod ojaxis eqimis kompetencia da resursi saSualebas iZleva marTos nebismieri simZimis akne Tumca dermatologis CarTva SesaZlebelia mkurnalobis nebismier fazaSi gasaTvaliswinebelia isic rom pacientebis didi nawili garkveuli drois ganmavlobaSi TviTmkurnalobas eweva da am procesSi TviTon Rebulobs gadawyvetilebas vis mimarTos pirveladad ojaxis

eqims Tu dermatologs137 praqtika gviCvenebs rom ojaxis eqims aramarto dermatologTan aramed SesaZloa sxva specialistebTanac dasWirdes pacientis referali

dermatologTan referals saWiroeben

pacientebi msubuqi da saSualo simZimis akneTi rodesac eqvsTviani konservatuli Terapiis Semdeg efeqti ar vlindeba

pacientebi romelTa daavadeba refraqterulia mkurnalobis mimarT gansakuTrebiT mZime aknes da nawiburebis SemTxvevaSi

pacientebi sistemuri izotretinoiniT kursis daniSvnisas ndash am SemTxvevaSi mkurnalobis meTods irCevs dermatologi magram gamomdinare medikamentis teratogenuli efeqtebidan izotretinoiniT mkurnalobis dawyebabmde erTi TviT adre fertiluri asakis qalebisaTvis aucilebelia kontraceptivebis daniSvna am periodiT pacienti meTvalyureobisaTvis kvlav ubrundeba pjd-s

pirveladi jandacvis doneze pacientis dabrunebis kriteriumebi

aknes stabilizacia

SerCeulia Terapiis gaumjobesebuli reJimi

damTavrebulia sistemuri izotretinoiniT mkurnalobis kursi

laboratoriuli kvlevebi (garkveuli periodulobiT) sistemuri izotretinoiniT mkurnalobis procesSi

referali endokrinologTan

saxezea hiperandrogenemiis niSnebi

referali fsiqologTan

saxezea fsiqikis sxvadasxva saxis dazianeba

21

8 xangrZlivi meTvalyureoba

mkurnalobis efeqturobis Sefaseba da gegmis gadaxedva yovel 2-3 TveSi erTxelaa saWiro

pacientebi romelTac mkurnaloba sistemuri retinoidebiT utardebaT mkurnalobis dawyebamde da Semdgom garkveuli periodulobiT unda CautardeT sisxlis saerTo analizi Sratis trigliceridebis qolesterinis RviZlis funqciuri testebis gansazRvra zogadad janmrTel asimptomur pirebs Soris romelTac diabetis an dislipidemiis ojxuri anamnezi ar aqvT laboratoriuli kvlevebis Catareba SesaZlebelia TveSi erTxel sxva SemTxvevaSi ki yovelkvireulad an or kviraSi erTxel manam sanam maCveneblebi rekomendebul zRvars ar miuaxlovdeba

izotretinoiniT mkurnalobis Sewyvetis Cvenebaa mZime hipertrigliceridemia (mag gt800 mgdl an 9 mmoll ndash mwvave pankreatitis ganviTarebis riskis gamo)105 an sxva gamoxatuli laboratoriuli cvlilebebi miuxedavad imisa rom izotretinoiniT mkurnalobis Sewyvetis Sedegad hipertrigliceridemia TandaTan wesrigdeba pacientebs mainc esaWiroebaT Semdgomi meTvalyureoba vinaidan erT-erTi kvlevis mixedviT maT momavalSi hiperlipidemiis da metaboluri sindromis ganviTarebis maRali riski aqvT106 rogorc aRmoCnda mikronizebuli izotretinoinis gamoyenebis SemTxvevaSi naklebia kankunTovani gverdiTi efeqtebis da hipertrigliceridemis ganviTarebis riski107

spironolaqtoniT mkurnalobis SemTxvevaSi Terapiis dawyebamde da Semdgom periodulad unda ganisazRvros sisxlSi eleqtrolitebis done

trimetroprimsulfomeToqsazoliT mkurnalobis dros saWiroa sisxlis saerTo analizis monitoringi

minocikliniT xangrZlivad sistemuri mkurnalobis (1 welze meti) SemTxvevaSi rekomendebulia antinuklearuli antisxeulebis da RviZlis transaminazebis gansazRvra

9 eTikur-samarTlebrivi sakiTxebi

aknes marTvis dros wamlis SerCevisas Zalze mniSvnelovania mkurnalobis sargeblobisa da riskis Sedareba radgan aknes samkurnalod gamoyenebuli wamlebis did nawils gamoxatuli gverdiTi efeqtebi axlavs Tan (sistemuri retinoidebi antibiotikebi spironolaqtoni da sxva) aucilebelia pacientis srulyofili informireba mkurnalobis miznebisa da yvela SesaZlo garTulebis agreTve samkurnalo saSualebebis xelmisawvdomobis Sesaxeb da misgan

22

informirebuli Tanxmobis miReba pacienti CarTuli unda iyos mkurnalobis Sesaxeb gadawyvetilebis miRebaSi sayuradReboa rom aknes samkurnalod mowodebuli wamlebis didi nawili Cveni qveynis farmacevtul bazarze registrirebuli araa rac SesaZlebelia gaidlainis implementaciis procesSi ganxorcieldes

10 praqtikaSi adaptaciis da protokolis SemuSavebis

rekomendaciebi

aknes gaidlainis danergva unda daiwyos miznebis dasaxviT da strategiis SemuSavebiT romelSic pirveladi jadacvis profesionalebTan erTad monawileobas miiReben meoreuli jandacvis profesionalebi pacientebi da aS

rekomendaciebi gaidlainis implementaciis Sesaxeb

gaidlainis danergvis (implementaciis) xelSemwyobi faqtorebi

daavadebis gavrcelebisa da problemurobis gamo misadmi gamoxatuli interesi samedicino profesionalebis mxridan

gaidlainis gamoyeneba ar saWiroebs raime axali unar-Cvevis aTvisebas

pirveladi jandacvis profesionalebis did nawils ukanaskneli 5-10 wlis manZilze gavlili aqvs mzadebis intensiuri kursi (rezidenturis moklevadiani kursi specialobaSi `saojaxo medicina~)

gaidlainis implementaciis rekomendebuli meTodebi

gaidlainebis gavrcelebaxelmisawvdomobis uzrunvelyofa

gaidlainis da Tanmxlebi masalebis xelmisawvdomobis uzrunvelyofa internetis gziT asociaciis veb-gverdi saministro da aS

gaidlainebis nabeWdi da kompiuteruli versiebis (kompaqt-diskze) gamravleba da samizne kontingentSi maTi gavrceleba

ganaTleba da treiningi

gaidlainSi mocemuli rekomendaciebis amsaxveli saganmanaTleblo masalebis gavrceleba

gaidlainis integrireba ojaxis eqimTa diplomisSemdgomi samedicino ganaTlebis (rezidenturis) programebSi maT Soris moklevadiani (gadamzadebis) programaSi

23

gaidlainze dafuZnebuli uwyveti samedicino ganaTlebis programebis SemuSaveba ojaxis eqimebisTvis

Tanmxlebi sainformacio sistemebis da Semaxseneblebis SemuSaveba da gavrceleba rogorc calkeuli eqimebis ise ganyofilebis doneze saqmianobis marTvisaTvis

saxelmwifo sasertifikacio gamocda

gaidlainebze dafuZnebuli kiTxvarebis CarTva saxelmwifo sasertifikacio gamocdebis testebSi specialobaSi `saojaxo medicina~

proeqtis pilotireba da profesiuli konsensusis miRweva

pirvel etapze romelime regionSi an pirveladi jandacvis ramdenime centrSi aknes marTvis gaidlainis pilotireba eqimisa da eqTnis gundis momzadeba Sesabamis specialistebTan ndash dermatologi endokrinologi fsiqologi TanamSromlobis uzrunvelyofa Sesabamisi wamlebis xelmisawvdomobis uzrunvelyofa xarisxis monitoringi

meore etapze pilitur proeqtSi monawile eqimebis Sexvedra pirveladi jandacvis sistemaSi momuSave sxva eqimebTan da gamocdilebis gaziareba sasurvelia Catardes konferencia sadac moxdeba gamocdilebis gaziareba

eqimebis CarTva gaidlainze dafuZnebuli auditis CatarebaSi informaciis moZieba da gamoqveyneba calkeul SemTxvevebSi eqimebis mier gaidlainis praqtikaSi gamoyenebis dadebiT Sedegebis Sesaxeb

sazogadoebis informireba

pacientebisaTvis sainformacio broSurebis momzadeba gaidlainebSi asaxuli rekomendaciebis Sesaxeb da im dawesebulebebSi myofi pacientebis gamoZaxilis moZieba da gamoqveyneba sadac gaidlaini dainerga

sadazRvevo kompaniebis informireba

gaidlainze dafuZnebiT auditis Catareba pirveladi jandacvis dawesebulebebSi

ukve momzadebuli kirteriumebis (ix zemoT) gamoyeneba auditisaTvis ojaxis eqimTa moklevadiani mzadebis programaSi CarTuli iqneba auditi aknes marTvis sakiTxebze

24

ew Semaxseneblebi samedicino personalisaTvis

plakatebis dabeWdva ojaxis eqimebisaTvis kanis daTvalierebisa da aknes diagnozis Sesaxeb agreTve aknes medikamenturi mkurnalobis algoirTmebis da adgilobrivi da sistemuri gamoyenebis wamlebis dozebis Sesaxeb

samkurnalo saSualebebis xelmisawvdomobis uzrunvelyofa

klinikuri praqtikis auditis kriteriumebi

auditis mizania gamovlindes ramdenad Seesabameba pirveladi jandacvis dawesebulebebis doneze Catarebuli aknes mkurnaloba gaidlainiT mowodebul rekomendaciebs

1 aknes identifikacia

12-25 wlis kontingentSi 80 aqvs sxvadasxva simZimis akne

2 pacientTa ra raodenobaSi moxda diagnostireba kanis SefasebiT

daavadebis diagnostika ZiriTadad kanis SefasebiT xdeba fizikuri gasinjvisas ganisazRvreba dazianebebis lokalizacia tipi (anTebiTi araanTebiTi) zoma (mcire lt5 mm ndash papulebi an pustulebi didi zomis gt5 mm ndash kvanZebi) daavadebis Sedegebi nawiburebi (atrofiuli gavrcelebuli hipertrofuli keloidi) hiperpigmentacia anTebisSemdgomi eriTema

3 pacientTa ra raodenobaSi moxda diagnostikisaTvis klinikur-laboratoriuli kvlevebis (androgenebis koncentracia sisxlSi) Catareba

klinikur-laboratoriuli kvlevebis Catareba (mag androgenebis koncentraciis gansazRvra sisxlSi) rutinulad saWiro araa maTi aucilebloba sxva Tanmxlebi niSnebis arsebobis SemTxvevaSi dgeba (mag hirsutizmi virilizaciis arseboba menstrualuri ciklis darRveva)

4 msubuqi aknes mqone pacientebis ra raodenobaSi dainiSna mkurnaloba daavadebis simZimis Sesabamisad

msubuqi araanTebiTi aknes dros mkurnaloba tardeba adgilobrivi komedolizuri saSualebebiT (adgilobrivi retinoidi benzoilis zeJangi azelainis mJava da aS)

msubuqi anebiTi aknes dros zemoT moxseniebul mkurnalobas emateba adgilobrivi antibaqteriuli saSualeba (eriTromicini klindamicini da aS)

25

5 pacientebis ra raodenobas Cautarda mkurnaloba aranakleb 8 kviris xangrZlivobiT

mikrokomedonebis maturacia 8 kviramde grZeldeba da aqedan gamomdinare efeqtis misaRebd mkurnalobis xangrZlivoba am periodze naklebi ar unda iyos

6 pacientebis ra raodenoba gaigzavna konsultaciis daan Semdgomi mkurnalobisaTvis specialistTan




daavadebis atipiuri formis dros

sistemuri izotretinoiniT mkurnalobis saWiroebisas

referali endokrinologTan rodesac saxezea hiperandrogenemiis niSnebi

referali fsiqologTan - saxezea fsiqikis sxvadasxva saxis dazianeba

7 pacientebis ra raodenobas Soris Sefasda mkurnalobis efeqturoba 2-3 TveSi erTxel

11 gaidlainis gadasinjvis da ganaxlebis vada - 2 weli

12 gaidlainis miRebis xerxiwyaro

gaidlaini warmoadgens sxvadasxva gaidlainebis (ix literatura) Sejerebis da adaptaciis Sedegs

1 Guidelines of care for acne vulgaris management (AM ACAD DERMATOL Apr 2007)

2 Acne management (Institute for Clinical Systems Improvement (AHRQ (US) ndash Agency

for Healthcare Research and Quality 01 January 2006)

3 Acne management (GAC (CA) ndash Guidelines Advisory Committee 01 October

2007 Canada)

4 acne vulgaris (PRODIGY Guidance) (SCHIN (GB) ndash Sowerby Centre for Health

Informatics at Newcastle Guideline 01 July 2006 United Kingdom)

26

mtkicebulebis done da rekomendaciebis xarisxi

done mtkicebulebis done xaris-

xi rekomendaciis xarisxi

I

Zlieri mtkicebuleba eyrdnoba minimum erT sistemur mimoxilvas romelic efuZneba swori dizainis mqone randomizebul kontrolirebad kvlevas

A

eyrdnoba I donis mtkicebulebas da Sesabamisad mtkiced rekomendebulia

II Zlieri mtkicebuleba eyrdnoba minimum erT swori dizainis mqone randomizebul kontrolirebad kvlevas

B

eyrdnoba II donis mtkicebulebas da Sesabamisad rekomendebulia

III klinikuri kvleva randomizaciis gareSe kohortuli da SemTxveva-kontrolis kvlevebi

C

eyrdnoba III donis mtkicebulebas SeiZleba CaiTvalos Sesabamisad

IV araeqsperimentuli multicentruli kvlevebi D

eyrdnoba IV da V donis mtkicebulebas saWiroebs konsesuss

Vა avtoritetul profesionalTa mosazreba

Vბ klinikuri gamocdileba aRwerilobiTi kvlevebi an eqspertTa angariSi

13 alternatiuli gaidlaini ar arsebobs

14 gamoyenebuli literatura

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27

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26 32 MeReC Bulletin Volume 10 Number 8 1999


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vulgaris in women Br J Dermatol 1986115227-32

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15 avtorTa jgufi

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akne axalgazrda asakis pirebis kanis erT-erTi yvelaze xSiri daavadebaa samedicinosTan erTad igi mniSvnelovani fsiqologiuri problemaa pacientisTvis

gaidlaini gankuTvnilia pirvelad jandacvaSi momuSave ojaxis eqimebisaTvis

aRniSnul gaidlainSi ganxilulia aknes mkurnaloba mozardebsa da mozrdilebs Soris igi ar moicavs daavadebis Sedegebis (nawiburebi anTebisSemdgomi eriTema an hiperpigmentacia) marTvis sakiTxebs

ganmarteba

akne kanis cximovani jirkvlebis anTebiTi daavadebaa qronikuli dermatozia da xasiaTdeba Ria daan daxuruli komedonebiT papulebiT pustulebiTa da kvanZovani gamonayariT

simZimis mixedviT ganarCeven daavadebis Semdeg formebs

msubuqi akne ndash komedonebi lt 20 araanTebiTi papulebi lt 15 an dazianebaTa ricxvi lt 30

saSualo simZimis Aakne ndash 15-50 papula da pustula komedonebiT iSviaTi kistebi totaluri dazianebebis ricxvi 30-125

mZime akne ndash pirveladi anTebiTi kvanZebi da kistebi aseve komedonebi papulebi da pustulebi totaluri dazianebebis ricxvi gt125

aknes dros ganviTarebuli gamonayaris tipebi

araanTebiTi

TeTri (anu daxuruli) komedonebi (araanTebiTi folikulebi romelTa Sesavali Seicavs keratinul sacobebs da dafarulia Txeli epidermuli membraniT)

Savi (anu Ria) komedonebi (araanTebiTi folikulebi romelTa Sesavali Seicavs keratinul sacobebs da Savi Seferiloba aqvs)

anTebiTi

papulebi

pustulebi

kvanZebi daan kistebi

3

2 epidemiologia



prognozi


3 etiopaTogenezi






anTebiTi procesi






4













5













6





20

gamokvlevebis gegma






xarisxi

mtkicebulebis

done literatura


7

6 mkurnaloba










8

benzoilis zeJangi








9




xarisxi

mtkicebulebis

done literatura












10












11





gamoyeneba





xarisxi

mtkicebulebis

done literatura




12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

3

2 epidemiologia



prognozi


3 etiopaTogenezi






anTebiTi procesi






4













5













6





20

gamokvlevebis gegma






xarisxi

mtkicebulebis

done literatura


7

6 mkurnaloba










8

benzoilis zeJangi








9




xarisxi

mtkicebulebis

done literatura












10












11





gamoyeneba





xarisxi

mtkicebulebis

done literatura




12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

4













5













6





20

gamokvlevebis gegma






xarisxi

mtkicebulebis

done literatura


7

6 mkurnaloba










8

benzoilis zeJangi








9




xarisxi

mtkicebulebis

done literatura












10












11





gamoyeneba





xarisxi

mtkicebulebis

done literatura




12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

5













6





20

gamokvlevebis gegma






xarisxi

mtkicebulebis

done literatura


7

6 mkurnaloba










8

benzoilis zeJangi








9




xarisxi

mtkicebulebis

done literatura












10












11





gamoyeneba





xarisxi

mtkicebulebis

done literatura




12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

6





20

gamokvlevebis gegma






xarisxi

mtkicebulebis

done literatura


7

6 mkurnaloba










8

benzoilis zeJangi








9




xarisxi

mtkicebulebis

done literatura












10












11





gamoyeneba





xarisxi

mtkicebulebis

done literatura




12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

7

6 mkurnaloba










8

benzoilis zeJangi








9




xarisxi

mtkicebulebis

done literatura












10












11





gamoyeneba





xarisxi

mtkicebulebis

done literatura




12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

8

benzoilis zeJangi








9




xarisxi

mtkicebulebis

done literatura












10












11





gamoyeneba





xarisxi

mtkicebulebis

done literatura




12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

9




xarisxi

mtkicebulebis

done literatura












10












11





gamoyeneba





xarisxi

mtkicebulebis

done literatura




12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

10












11





gamoyeneba





xarisxi

mtkicebulebis

done literatura




12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

11





gamoyeneba





xarisxi

mtkicebulebis

done literatura




12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

12






nawiburovani akne


ganmeorebiTi akne

fulminanturi akne





13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

13




mtkicebulebis done

literatura



14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

14


samkurnalo

saSualeba dozireba

gamoSvebis



tretinoini

(Tretinoin)


0025 kremi

001 geli

005 kremi

0025 geli

01 kremi

005 xsnari


adapaleni

(Adapalene)



tazaroteni


005 geli

01 geli


benzoilis

zeJangi (Benzoyl

peroxide)







metronidazoli


1 kremi

075 geli

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

15

klindamicini


10 mgml geli

10mgml losioni



eriTromicini


15 xsnari

2 xsnari

2 geli

2 malamo

2 kompresi

azelainis mJava



tetraciklini

(Tetracycline)



doqsiciklini


minociklini

(Minocycline)



eriTromicini

(Erythromycin)



oraluri retinoidi

izotretinoini

(Isotretinoin)




16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

16

sxva mkurnaloba






xarisxi

mtkicebulebis

done

literatura





17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

17









sqema 2




pasuxi mkurnalobaze




18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

18





algoriTmi sqema 3


gansazRvra


+


an azelainis mJava

pasuxi mkurnalobaze




19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

19






referali



pasuxi mkurnalobaze



nawiburebi


+ benzoilis zeJangi






an


20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

20

7 referali








aknes stabilizacia








21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






200451348









199737746-54






32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

21










22



rekomendaciebi














23














24















25



















2007 Canada)



26




I


A



B



C











Dermatol 1978 71324






Dermatol 1997 13666


Dermatol 2001 45957






27






119570












Dermatol 1980 102277-80



Drugs 199549(suppl 2)164-7















197923856-9




19802590-2





197414882-9


197467683-7






28






























1998139(suppl 52)41-7






199838S17-23






Cutis 2001 674






Dermatol 1996 34482



Dermatol 19839933-6

29










Dermatol 199737590-5)







Dermatol 1981117551-3





198512526-31


















198914335-9












30








142638





334154












7




Med J 197669695-7











64










1972145187-91



31



















19826735-45














200145196-207






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mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

32




200247399-409






19852911231-5






200277713-716


Pediatr 2000136688-690


15 avtorTa jgufi


avtorebi


eqspertebi





mkurnalobis

gagrZeleba


s Semcireba

an mkurnalo

bis Sewyveta

aknes marTva pirvelad jandacvaSi · akne da oligomenorea aReniSneba gamokvleuli unda iqnes pss-ze....

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Transcript of aknes marTva pirvelad jandacvaSi · akne da oligomenorea aReniSneba gamokvleuli unda iqnes pss-ze....