asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/akh2023-012asurgery-352Research ArticleФЛЕБОЛОГИЯPHLEBOLOGYГиперпигментация после склеротерапии: современные возможности профилактики и леченияHyperpigmentation after sclerotherapy: modern possibilities for prevention and treatmenthttps://orcid.org/0000-0002-3940-0787БогачевВ. Ю.BogachevV. Yu.

Богачев Вадим Юрьевич, д.м.н., профессор, профессор кафедры факультетской хирургии №2, 

117997, Москва, ул. Островитянова, д. 1

Vadim Yu. Bogachev, Dr. Sci. (Med.), Professor of the Department of Faculty Surgery No. 2,

1, Ostrovityanov St., Moscow, 117997

vadim.bogachev63@gmail.comhttps://orcid.org/0000-0003-4488-9123БолдинБ. В.BoldinB. V.

Болдин Борис Валентинович, д.м.н., профессор, заведующий кафедрой факультетской хирургии №2, 

117997, Москва, ул. Островитянова, д. 1

Boris V. Boldin, Dr. Sci. (Med.), Professor, Head of the Department of Faculty Surgery No. 2,

1, Ostrovityanov St., Moscow, 117997

bvb195411@mail.ruhttps://orcid.org/0000-0001-8982-7095АлуханянО. А.AlukhanyanO. A.

Алуханян Овик Арменович, д.м.н., профессор кафедры кардиохирургии и кардиологии факультета повышения квалификации и профессиональной переподготовки специалистов, 

350063, Краснодар, ул. Митрофана Седина, д. 4

Ovik A. Alukhanyan, Dr. Sci. (Med.), Professor of the Department of Cardiac Surgery and Cardiology, Faculty of Vocational Education and Professional Retraining of Specialists, 

4, Mitrofan Sedin St., Krasnodar, 350063

alovik@yandex.ruhttps://orcid.org/0000-0002-6262-4770ТуркинП. Ю.TurkinP. Yu.

Туркин Павел Юрьевич, к.м.н., доцент кафедры факультетской хирургии №2, 

117997, Москва, ул. Островитянова, д. 1

Pavel Yu. Turkin, Cand. Sci. (Med.), Associate Professor of the Department of Faculty Surgery No. 2, 

1, Ostrovityanov St., Moscow, 117997

pavelturkin@gmail.comhttps://orcid.org/0009-0003-1541-3027ЛобановВ. Н.LobanovV. N.

Лобанов Виктор Николаевич, врач-хирург, сосудистый хирург, генеральный директор, 

117447, Москва, ул. Дмитрия Ульянова, д. 31

Victor N. Lobanov, Surgeon, Vascular Surgeon, General Director, 

31, Dmitry Ulyanov St., Moscow, 117447

lobanovic@yandex.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationКубанский государственный медицинский университетРоссияKuban State Medical UniversityRussian FederationПервый флебологический центрРоссияFirst Phlebological CenterRussian Federation2023190520232018193Copyright © Богачев В.Ю., Болдин Б.В., Алуханян О.А., Туркин П.Ю., Лобанов В.Н., 20232023Богачев В.Ю., Болдин Б.В., Алуханян О.А., Туркин П.Ю., Лобанов В.Н.Bogachev V.Y., Boldin B.V., Alukhanyan O.A., Turkin P.Y., Lobanov V.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/352

Склеротерапия служит одним из самых популярных и наиболее часто используемых методов удаления расширенных ретикулярных вен и телеангиэктазий нижних конечностей. Несмотря на огромный коллективный опыт, эта процедура может сопровождаться рядом нежелательных побочных явлений, самым неприятным из которых выступает постинъекционная гиперпигментация, частота которой достигает 80%. Развитие гиперпигментации после склеротерапии (ГПС) связано с экстравазацией и разрушением эритроцитов, в результате которого гемоглобин трансформируется в пигмент гемосидерин. По своей сути ГПС служит вариантом посттравматической гемосидериновой пигментации. Вероятность возникновения и стойкость ГПС определяются рядом трудно контролируемых факторов, среди которых калибр и локализация целевой вены, вид, концентрация и агрегатное состояние склерозирующего вещества, техника склеротерапии, способ и длительность постпроцедурной компрессии, этническая принадлежность пациента, нарушения метаболизма железа, сопутствующий прием ряда лекарственных препаратов, фаза менструального цикла у женщин и т. д. Гиперпигментация значительно снижает качество жизни пациентов, что определяет необходимость профилактики и лечения этого нежелательного побочного явления флебосклерозирующего лечения. С целью профилактики ГПС рекомендован тщательный сбор анамнеза, направленный на выявление возможных факторов риска, при наличии которых в постпроцедурном периоде целесообразно использовать различные системные и местные лекарственные препараты, препятствующие отложению гемосидерина в коже, а также применять режим пролонгированной компрессии. В случае развития ГПС могут быть реализованы процедуры, направленные на разрушение и утилизацию гемосидерина, такие как лазер Q-Switched и IPL-терапия, а также различные варианты пилинга, призванные ускорить замещение пигментированной кожи на нормальную. В отношении профилактики и лечения ГПС вызывает интерес использование препарата Контрактубекс, представляющего собой комбинацию экстракта лука – цепалина, аллантоина и гепарина. Контрактубекс – препарат, изначально предназначенный для оптимизации заживления ран и профилактики образования гипертрофических рубцов. Вместе с тем существует большое количество публикаций, в которых обсуждаются возможности этого препарата для коррекции посттравматической гиперпигментации за счет сочетанного действия компонентов. Наш клинический опыт подтверждает эффективность Контрактубекса при лечении ГПС, что определяет целесообразность проведения полноценных клинических исследований и накопления большего коллективного опыта в этом направлении. 

Sclerotherapy is one of the most popular and most common techniques for the removal of delated reticular veins and telangiectasias on the lower limbs. Despite the vast pooled experience, this procedure can be accompanied by a number of undesirable side effects, of which post-injection hyperpigmentation, which frequency reaches 80%, is the most unpleasant one. The development of postsclerotherapy hyperpigmentation (PSHP) is associated with extravasation and destruction of red blood cells, which results in transformation of haemoglobin into hemosiderin pigment. PSHP is, by definition, a variant of post-traumatic hemosiderin pigmentation. The likelihood of occurrence and persistence of PSHP is determined by a number of hard controllable factors, including the calibre and location of the target veins, the type, concentration and physical form of the sclerosing agent, the sclerotherapy technique, the method and duration of post-procedural compression, patients’ ethnicity, iron metabolism disorders, concomitant use of a number of drugs, a menstrual cycle phase in women, etc. Hyperpigmentation significantly decreases the patients’ quality of life, which determines the need for the prevention and treatment of this undesirable side effect of phlebosclerosing treatment. Recommendations for prevention of PSHP include a detailed history taking aimed at identifying potential risk factors, in the presence of which it is advisable to use various systemic and topical drugs in the post-procedural period in order to prevent the skin hemosiderin deposition, as well as to apply the extended-cycle compression. In the case of PSHP, procedures aimed at the destruction and utilization of hemosiderin, such as Q-Switched laser and IPL therapy, as well as various peeling options intended to speed up the replacement of pigmented skin with normal, can be applied. For the PSHP prevention and treatment, the use of Contractubex containing cepalin onion extract in combination with allantoin and heparin is a matter of interest. Contractubex is a drug originally intended to optimize wound healing and prevent the formation of hypertrophic scars. At the same time, there is ample publications discussing the possible use of this drug for the management of post-traumatic hyperpigmentation due to the combined action of its components. Our clinical experience confirms the effectiveness of Contractubex in the treatment of PSHP, which determines the feasibility of conducting full-fledged clinical trials and accumulating more pooled experience in this area. 

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