ACNE VULGARIS: PATHOGENETIC MECHANISMS AND INTEGRATED APPROACHES TO ANTIBACTERIAL AND IMMUNOMODULATORY THERAPY

Abstract

Acne vulgaris is one of the most common chronic inflammatory dermatoses, predominantly affecting adolescents and young adults and significantly impairing quality of life. Despite advances in dermatology, the disease remains characterized by a recurrent course, therapy resistance, and a pronounced psychosocial burden. Contemporary concepts regard acne as a multifactorial disorder involving follicular hyperkeratosis, sebaceous gland hyperactivity, dysbiosis of the skin microbiota, and dysregulation of innate and adaptive immune responses. Particular importance is attributed to the role of Cutibacterium acnes and immune insufficiency, including impaired phagocytosis, altered T-lymphocyte subpopulations, and decreased interferon production. This article analyzes modern pathogenetic mechanisms of papulopustular acne vulgaris and substantiates the rationale for integrated therapy combining systemic macrolide antibiotics with interferon inducers. Clinical, microbiological, immunological, and quality-of-life outcomes are discussed, demonstrating that combined antibacterial and immunomodulatory therapy provides superior clinical efficacy, normalization of skin microbiocenosis, restoration of immune parameters, and prolonged remission compared to standard treatment. The presented data support the use of pathogenetically oriented combination therapy as a promising strategy for improving long-term outcomes in patients with inflammatory acne.