medecolМедицина и экологияMedicine and ecology2305-60452305-6053Карагандинский медицинский университет10.59598/ME-2305-6053-2026-120-3-42-54medecol-1368Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSГистологическая оценка влияния системного изотретиноина на кожуHistological evaluation of systemic isotretinoin’s effect on the skinСтабаеваЛ. М.StabayevaL. M.

100000, г. Караганда, ул. Ерубаева, 43

100012, Karaganda c., Yerubayeva str., 43

okb@okbkar.kzБесплемяннаяК. Д.BesplemyannayaX. D.

Ксения Дмитриевна Бесплемянная 

100008, г. Караганда, ул. Гоголя, 40

Xeniya Dmitrievna Besplemyannaya 

100008, Karaganda c., Gogolya str., 40

xenia.besplemyannaya@mail.ruНыгызбаеваР. Ж.NygyzbayevaR. Zh.

100000, г. Караганда, ул. Ерубаева, 43

100012, Karaganda c., Yerubayeva str., 43

okb@okbkar.kzЭдиО. В.EdiO. V.

100008, г. Караганда, ул. Муканова, 5/3

100008, Karaganda c., Mukanova str., 5/3

mbmak@maqajanov.kzПановаМ. К.PanovaM. K.

100024, г. Караганда, пр-т Шахтеров, 83

100024, Karaganda c., Shakhtyorov ave., 83

kgp_odkb@mail.ruКГП «Областная клиническая больница»КазахстанMSE «Regional clinical hospital»KazakhstanНАО «Карагандинский медицинский университет»КазахстанNC JSC «Karaganda Medical University»KazakhstanКГП «Многопрофильная больница им. проф. Х. Ж. Макажанова»КазахстанMSE «Kh. Zh. Makazhanov Multidisciplinary Hospital»KazakhstanКГП «Областная детская клиническая больница»КазахстанMSE «Regional Children’s Clinical Hospital»Kazakhstan202612102026034254Copyright © Стабаева Л.М., Бесплемянная К.Д., Ныгызбаева Р.Ж., Эди О.В., Панова М.К., 20262026Стабаева Л.М., Бесплемянная К.Д., Ныгызбаева Р.Ж., Эди О.В., Панова М.К.Stabayeva L.M., Besplemyannaya X.D., Nygyzbayeva R.Z., Edi O.V., Panova M.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medecol.qmu.kz/jour/article/view/1368

В представленном обзоре собраны данные о гистоморфологических изменениях дермы на фоне применения изотретиноина. Проведен систематизированный поиск научных публикаций в период с января 1980 по январь 2026 г. В анализ включались оригинальные исследования, клиникоморфологические работы, экспериментальные исследования и обзорные публикации, посвященные морфологическим изменениям кожи при системной терапии изотретиноином. Релевантный поиск выдал 409 статьи, после первичного изучения для итогового анализы было отобрано 25 статей, 19 из которых направлены на изучение анти-акне эффекта и еще 6 наблюдали инволюцию признаков фотостарения на фоне применения изотретиноина. На основании анализа литературы собраны данные о гистологических изменениях кожи на фоне применения системного изотретиноина как со стороны сальных желез, так и со стороны дермы. Данные упорядочены и оформлены в единую таблицу.

Применение изотретиноина системно вызывает целый ряд изменений в коже, подтвержденных клинически и гистологически. В частности, сальные железы значительно редуцируются (до 90 %), происходит ингибирование дифференциации себоцитов. Структура желез становится удлиненной, «ячеистой» с небольшим количеством себоцитов, остающихся в центре, на базальной пластинке. Количество цитоплазмы по сравнению с размерами ядра уменьшается на 35 %, наблюдается заметное уменьшение количества незрелых клеток и никаких митотических цифр. Количество частично дифференцированных клеток очень малое, а большинство клеток зрелые и полные липидных капель. Было зафиксировано разрушение десмосом, нарушение связи между ороговевшими кератиноцитами, следовательно, микрокомедоны регрессировали, а сальные нити значительно уменьшались клинически. Фолликулярная кератинизация снизилась на 55-70 %. В комедонах заметно уменьшалось количество кожного сала и бактерий.

В контексте влияния на фотостарение были выявлены следующие гистологические изменения: значительное увеличение толщины эпидермиса, уменьшение эластоза, снижение эпидермального р53, выпрямление сосочков дермы, улучшение трофики, уменьшение воспалительного инфильтрата и снижение степени базофильной дегенерации коллагена, увеличение его плотности и концентрации. Уменьшение количества и изменения эластичных волокон: эластические волокна до лечения были более спутанными и фрагментированными, после – более фибриллярными и цельными.

The presented literature review contains data on histomorphological changes in the dermis when using isotretinoin. The systematic search was conducted for the results of scientific studies published between January 1980 and January 2026. The analysis included original researches, clinical and morphological work, experimental studies and review publications on morphological changes in the skin during systemic isotretinoin therapy. The result of the relevant search turned out to be 409 articles, of which, after the initial study, 25 articles were selected for final analysis: 19 articles were devoted to the anti-acne effect, the remaining 6 articles – to the involution of signs of photoaging against the background of the use of isotretinoin. Based on the literature analysis, data were collected on histological changes in the skin during the systemic use of isotretinoin from both the sebaceous glands and the dermis.

Systemic use of isotretinoin caused a number of changes in the skin, confirmed clinically and histologically. In particular, sebaceous glands were significantly reduced (up to 90%), and sebocyte differentiation was inhibited. The structure of the glands became elongated, «cellular» with a small number of sebocytes remaining in the center, on the basal plate. The amount of cytoplasm decreased by 35% compared to the size of the nucleus. There was a noticeable decrease in the number of immature cells and there was no mitotic numbers. The number of partially differentiated cells was very small, most of the cells were mature and full of lipid droplets. Desmosome destruction and disruption of links between keratinized keratinocytes were recorded, therefore, microcomedones regressed, and sebaceous filaments significantly decreased clinically. Follicular keratinization decreased by 55-70%. The amount of sebum and bacteria in comedones decreased markedly.

In the context of the effect of isotretinoin on photoaging, the following histological changes were identified: the significant increase in epidermal thickness, the decrease in elastosis, the decrease in epidermal p53, the straightening of the papillae of the dermis, the trophism improvement, the decrease in inflammatory infiltrate and in the degree of basophil degeneration of collagen, the increase in its density and concentration. There was the decrease in the number and changes in elastic fibers: elastic fibers were more tangled and fragmented before treatment, and more fibrillar and whole after treatment.

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The authors declare that there are no conflicts of interest present.