RU2252014C1 - Method for choosing therapy in case of acne - Google Patents

Abstract

FIELD: medicine, cosmetology.

SUBSTANCE: one should detect the scope of eruption, the availability of psychoemotional disorders, then, by taking into consideration patient's sex it is necessary to calculate Monakhov's therapeutic acne index (MTAI) by a certain formula to prescribe therapy by taking into account the index obtained. The present innovation provides individual approach to prescribing anti-acne therapy that, in its turn, enables to shorten the terms of disease, decrease the number of jatrogenic complications and prolong remission period.

EFFECT: higher efficiency of anti-acne therapy.

13 ex, 4 tbl

Description

The invention relates to medicine, specifically to new methods of treatment, and may find application in the treatment of acne.

Acne (acne vulgaris, acne) is one of the most common inflammatory skin diseases, affecting up to 85% of people aged 12 to 24 years.

A known method of treating acne, based on an algorithm that takes into account the severity of acne and is based on the stage-by-stage administration of anti-acne agents. For mild, moderate, severe inflammatory acne and severe non-inflammatory, sebosuppressive therapy is prescribed (retinoids, antiandrogens, estrogens). If this therapy is not effective, then local and systemic antibiotics are prescribed. If antibiotic therapy is ineffective, drugs that normalize keratinization of the duct of the sebaceous hair follicle (retinoids, adapalene). The last stage of acne therapy is vitamin therapy, the appointment of immunomodulators, lipotropic drugs. With a mild severity of non-inflammatory acne, retinoids or adapalene are administered, and if it is ineffective, vitamin therapy, immunomodulators, and lipotropic drugs are prescribed. With moderate and severe severity of non-inflammatory acne, the algorithm is similar to the staged principle for the treatment of inflammatory acne with the exception of the antibiotic therapy stage (Zabnenkova O.V. Modern aspects of the etiopathogenesis of acne vulgaris. The main directions of treatment for this disease // Experimental and clinical dermatocosmetology. - 2003. - No. 1 . - S.53-61).

However, the disadvantage of this method is the lack of clear criteria for determining the severity of acne.

Closest to the proposed method is a therapeutic algorithm proposed by V.P. Adaskevich. The choice of local, systemic drugs and combination regimens is determined by the severity of acne. The relatively mild form requires only local therapy: benzene peroxide, azelaic acid, retinoids, antibiotics and various local combination drugs. After 2-3 months, with good effect, the selected therapy is continued, in the absence of effect, the drug is changed or treatment is carried out according to the scheme as with moderate severity. For moderate severity, local retinoids, benzoyl peroxide, azelaic acid, systemic antibiotics, hormonal drugs are used. After 2-3 months, with a good effect, the selected therapy is continued, in the absence of effect, the drug is changed or treatment is carried out according to the scheme as in severe severity, i.e. systemic isotretinoin (Adaskevich VP Acne vulgar and pink. - M .: Medical book, N. Novgorod: Publishing house NGMA, 2003. - 160 p.).

The disadvantages of this method is the low effectiveness of treatment and, as a result, the formation of psychoemotional disorders.

The objective of the invention was to increase the effectiveness of the treatment of acne and the elimination of psychoemotional disorders.

The problem is solved by a method that includes assessing the severity and prevalence of skin lesions, the gender of the patient, the presence of psychoemotional disorders (PER) and the calculation of the therapeutic index of acne Monakhova (TIAM) by the formula

The values of the elements of the formula a (account), c (chest), n (nature), e (emotional) are determined by the corresponding rating scales for each value.

The classification proposed by the American Academy of Dermatology (cited by V. Adaskevich VP Acne vulgar and pink.) Was taken as the basis for assessing the severity of acne (CTA). - M.: Medical book, N. Novgorod: NGMA Publishing House, 2003. - 160 p. .):

I CTA is characterized by the presence of comedones and single papules;

II CTA - papular rash and a small amount of pustules;

III CTA - along with a pronounced papulopustular rash, up to 3-5 nodes are found,

IV CTA is characterized by a pronounced inflammatory reaction in the deep layers of the dermis with the formation of multiple painful nodes and cysts.

In the process of creating the proposed invention, rating scales were developed to determine the numerical values of the elements of the mathematical formulas “a”, “c”, “n”, “e”:

Scale for determining the value of “a” STA I II III IV The value of “a” 1 2 3 4 Scale for determining the value of “c” Localization of acne face face and torso The value of "c" 1 2 Scale for determining the value of “n” Patient gender male female The value of "p" 1 2 Scale for determining the value of “e” PEER not there is The value of “e” 0 1

When calculating, TIAM takes numerical values that determine the tactics for prescribing the type of therapy to a patient with acne, depending on gender, CTA, the prevalence of skin lesions and the presence of PER (see Table 1).

The method is as follows.

After evaluating the complaints and medical history, the dermatologist estimates the severity of acne on a four-level scale proposed by the American Academy of Dermatology, and the value “a” is determined by the rating scale. Then, the prevalence of acne rashes is determined - face or face and trunk, and the value “c” is determined on a rating scale. Depending on the gender of the patient, an “n” value is determined on a rating scale. A clinical psychodiagnostic study (conversation with the patient) allows you to identify the presence of psychoemotional disorders as a result of a cosmetic defect, and the value “e” is determined on a rating scale. Substituting the corresponding numerical values in the formula of TIAM, arithmetic calculation of the index is performed. The obtained numerical value is compared with the value of the evaluation table of numerical values of TIAM and a specific treatment regimen is assigned to the patient.

For ease of use, a computer program has been developed based on the index, which allows the selection of therapy according to the specified parameters without mathematical calculations and with minimal skills on a personal computer.

Object of study:

223 patients diagnosed with acne. Among the examined there were 96 (43%) men and 127 (57%) women. The age of patients ranged from 15 to 32 years.

Methods of examination and treatment:

The distribution of acne patients depending on the severity of acne and the localization of rashes is presented in table 2. Psychoemotional disorders of varying severity were detected in 92 patients (30 men, 62 women) - see table 3.

table 2
Distribution of patients depending on STA and process localization Face Face + Torso STA Patient gender abs. % abs. % I husband. 14 14.6 - - wives 25 19.7 - - II husband. 19 19.8 eleven 11.5 wives fifteen 11.8 eighteen 14.2 III husband. 19 19.8 6 6.2 wives twenty 15.7 47 37.0 IV husband. 6 6.2 21 21.9 wives - - 2 1,6 Table 3
The incidence of psychoemotional disorders in patients with acne, depending on the gender and severity of skin lesions Acne Severity I II III IV Psychopathological syndrome floor abs. % abs. % abs. % abs. % Depressive syndrome m - - 4 14.2 4 14.3 1 3.6 well 2 3.2 12 19.3 8 12.9 - - Hypochondria syndrome m - - 3 10.7 2 7.1 2 7.1 well 3 4.8 7 11.3 6 9.7 - - Asthenic syndrome m - - 2 7.1 - - 3 10.7 well 4 6.4 7 11.3 2 3.2 - - Dysmorphophobic Syndrome m - - 2 7.1 - - - - well 4 6.4 5 8.1 1 1,6 - - Fixing ideas m - - 1 3.6 - - - - well 2 3.2 4 6.4 - - - - Suicidal ideology m - - - - - - 1 3.6 well - - - - 1 1,6 - -

Methods of treatment: on the basis of an assessment of the medical history of the disease (previous anti-acne therapy), the severity and prevalence of skin lesions, the patient’s gender, all 223 patients were divided into three groups depending on the type of anti-acne therapy prescribed.

The first group included 132 patients (69 men, 63 women) with the severity of skin lesions I-III and the localization of the process on the face or face and trunk.

The subgroup “1A” included 14 men and 25 women with STA I and localization of the process on the face. These patients received therapy with a complex of therapeutic cosmetics for 3 months.

Example 1: Patient F. (n = 2), 20 years old, suffers from acne for 3 years, has not been treated before. On examination: STA I (a = 1), localization of rashes on the face (c = 1), the psychoemotional sphere is not broken (e = 0), TIAM = 4. The therapy was prescribed with a complex of medical cosmetics (washing gel, cream and “Keraknil” mask) for a period of 3 months. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 23-3.2; closed comedones: 28.4-5.6; papules: 5.5-1.9.

Example 2: patient K. (n = 2), 22 years old, suffers from acne for 5 years, has previously received erythromycin courses for acne several times, used Skinoren cream, Vidal milk, various cosmetic creams and masks with little effect. On examination: STA I (a = 1), localization of rashes on the face and trunk (c = 2), during a psychodiagnostic conversation, hypochondriac syndrome and ideas of fixation on the skin were revealed, the patient complained of “large spots” on the face skin, unusual a variant of acne in which the currently known remedies are ineffective (e = 1), TIAM = 1.4. In parallel with dermatological treatment, according to gender, severity and prevalence of skin lesions (a complex of therapeutic cosmetics for a period of 3 months), psychopharmacotherapy with Sonapax was prescribed 10 mg 3 times a day for a period of 1 month. After 4 weeks, acne regressed by about 30%, the patient also noted a significant improvement in the skin process, gained faith in cure, provided that therapy was continued for at least another 2 months. “Sonapax” was canceled and local therapy continued with the “Keraknil” complex of therapeutic cosmetics. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 17-2; closed comedones: 24-3; papules: 14-2; pustules: 5-0.

Subgroup “1B” consisted of 19 men and 15 women with STA II and localization of the process on the face, who received monotherapy with 0.1% gel adaptale (“Differin”) for 3 months.

Example 3: sick Sh. (N = 2), 22 years old, suffers from acne for 4 years, has not been treated before. On examination: STA II (a = 2), localization of rashes on the face (c = 1), the psychoemotional sphere is not broken (e = 0), TIAM = 11. He was prescribed therapy with 0.1% adaptale gel (Differin) for a period of 3 months. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 17-2; closed comedones: 24-3; papules: 14-2; pustules: 5-0.

Example 4: Patient Yu (n = 2), 23 years old, suffers from acne for 6 years, has previously received erythromycin courses for acne several times, applied Skinoren cream, Vidal milk with little effect. On examination: STA II (a = 2) localization of rashes on the face (c = 1), a psychodiagnostic conversation revealed a depressive syndrome formed under the influence of a cosmetic defect, the patient was not tuned for a 3-month treatment period, citing the fact that “If for 6 years the doctors could not help her, then in 3 months - even more so” (e = 1), TIAM = 1.5. In parallel with dermatological treatment, according to gender, severity and prevalence of skin lesions (0.1% gel adaptalen (“Differin”) for a period of 3 months), psychopharmacotherapy was prescribed with the antidepressant “amitriptyline” 25 mg 2 times a day for a period of 1 month. After 4 weeks, acne regressed by about 40%, the patient also noted a significant improvement in the skin process, gained faith in cure, provided that therapy was continued for at least another 2 months. “Amitriptyline” was canceled and local therapy with 0.1% Differin gel was continued. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 17-2; closed comedones: 24-3; papules: 14-2; pustules: 5-0.

Subgroup “1B” consisted of 2 men and 11 women with CTA III and 11 men with CTA II. In all patients, the process was mainly localized on the face. Given the absence of previous courses of antibiotic therapy for acne, most patients in this subgroup were prescribed combination therapy with 0.1% gel or 0.1% adapalene cream (Differin) in combination with 1% clinamycin phosphate gel (Dalacin T) for three months.

Example 5: patient K. (n = 1), 21 years old, suffers from acne for 6 years, previously treated with azelaic acid without significant improvement. On examination: STA III (a = 3), localization of rashes on the face (c = 1), the psychoemotional sphere is not broken (e = 0), TIAM = 29. He was prescribed therapy with 0.1% adapalene gel (Differin) in combination with 1% clindamycin phosphate gel (Dalacin T gel) for a period of 3 months. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 23-2; closed comedones: 18-3; papules: 25-3; pustules: 17-0; nodes: 4-1.

The 1G subgroup included 17 men and 9 women with STA III and localization of the process on the face. Most of these patients did not report improvement from previous courses of antibiotic therapy. In this regard, for 3 months these patients received therapy with 5% benzoyl peroxide gel with an acrylate co-polymer plus glycerin complex (Baziron AS gel), and after the disappearance of pustulation, 0.1% Differin gel was added to the therapy .

Example 6: patient D. (n = 1), 23 years old, suffers from acne for 6 years, was previously treated with erythromycin per os for two months without significant improvement. On examination: STA III (a = 3) localization of rashes on the face (c = 1), the psychoemotional sphere is not broken (e = 0), TIAM = 29. Sequential therapy with 5% Baziron AS gel was prescribed, followed by 0.1% Differin gel therapy for 3 months. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 22-0; closed comedones: 27-2; papules: 32-5; pustules: 16-0; knots: 3-0.

The subgroup “1D” included 6 men and 3 women with STA III and localization of the process on the face and body. Combination therapy with 0.1% adaptale gel (Differin) and tetracycline per os was prescribed to men, taking into account the severity of skin lesions and the prevalence of the process. The duration of treatment was 3 months.

Example 7: patient B. (n = 1), 22 years old, suffers from acne for 5 years, has not been treated before. On examination: STA III (a = 3) localization of rashes on the face and trunk (c = 2), the psycho-emotional sphere is not broken (e = 0), TIAM = 32. He was prescribed therapy with 0.1% adaptale gel (Differin) in combination with tetracycline per os for a period of 3 months. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 27-5; closed comedones: 27 - 2; papules: 32-5; pustules: 16-0; knots: 3-0.

The second group consisted of 62 women who received anti-acne therapy with combined oral contraceptives for 6 months. Since 0.03 mg of ethinyl estradiol with 2 mg of dienogest (“Janine”) and 0.035 mg of ethinyl estradiol with 2 mg of cyproterone acetate (“Diane-35”) have an antiandrogenic effect, hirsutism is present when women are divided into subgroups “2A” or “2B” or an increase in serum free testosterone was not considered.

The subgroup “2A” (0.035 mg of ethinyl estradiol with 2 mg of cyproterone acetate) included 44 women with STA III and the localization of the process on the face and body, the subgroup “2A” (0.03 mg of ethinyl estradiol with 2 mg of dienogest) - 18 women with STA II and localization of the process on the face and body.

Example 8: patient C. (n = 2), 27 years old, suffers from acne for 9 years, was previously treated with erythromycin per os for two months, Vidal milk, azelaic acid without significant improvement. On examination: STA III (a = 3) localization of rashes on the face and trunk (c = 2), the psycho-emotional sphere is not broken (e = 0), TIAM = 33. The DOC-35 COC therapy was prescribed for a period of 6 months. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 29-6; closed comedones: 23-6; papules: 29-3; pustules: 18-0; knots: 4-0.

Example 9: patient Z. (n = 2), 21 years old, suffers from acne for 5 years, has not previously been treated. On examination: CTA II (a = 2), localization of rashes on the face and trunk (c = 2), the psycho-emotional sphere is not broken (e = 0), TIAM = 14. COC “Janine” therapy was prescribed for a period of 6 months. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 19-3; closed comedones: 28-6; papules: 23-2; pustules: 5-0.

Example 10: Patient S. (n = 2), 24 years old, suffers from acne for 6 years, has previously received doxycycline courses on acne several times, used 0.01% retinoic ointment, and Vidal milk with little effect. On examination: CTA II (a = 2), localization of rashes on the face and trunk (c = 2), a psychodiagnostic conversation revealed a depressive syndrome formed under the influence of a cosmetic defect, the patient was not configured for a 6-month treatment period for COCs (e = 1), THIAM = 1.7. In parallel with dermatological treatment in accordance with gender, severity and prevalence of skin lesions (COC “Janine”) for a period of 6 months), psychopharmacotherapy was prescribed with the antidepressant “amitriptyline” 25 mg 2 times a day for a period of 3 months. After 3 months, acne regressed by about 60%, the patient also noted a significant improvement in the skin process, gained faith in cure, provided that therapy was continued for at least 3 more months. “Amitriptyline” was canceled and continued treatment of the COC “Zhania". Dynamics of rashes (before and after therapy, p <0.001): open comedones: 17-2; closed comedones: 24-3; papules: 14-2; pustules: 5-0.

The third group consisted of 29 patients (27 men, 2 women) with CTA IV. In 6 men, the process was localized mainly on the face, in 21 men and 2 women - on the face and body. The duration of per os isotretinoin therapy (Roaccutane) was 5.5–6.5 months.

Example 11: patient I. (n = 1), 22 years old, suffers from acne for 4 years, was previously treated with erythromycin per os for one month, Vidal milk, azelaic acid without significant improvement. On examination: STA IV (a = 4), localization of rashes on the face (c = 1), the psychoemotional sphere is not broken (e = 0), TIAM = 69. Isotretinoin per os therapy (Roaccutane) was prescribed for a period of 6.5 months. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 46-4; closed comedones: 52-8; papules: 36-1; pustules: 26-0; knots: 24-0.

Example 12: patient B. (n = 1), 23 years old, suffers from acne for 6 years, was previously treated with tetracycline per os for 1.5 months, Vidal's milk, opening of inflammatory elements without significant improvement. On examination: CTA IV (a = 4), localization of rashes on the face and trunk (c = 2), the psychoemotional sphere is not broken (e = 0), TIAM = 69. Isotretinoin per os therapy was prescribed for a period of 6 months. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 57-7; closed comedones: 62-10; papules: 44-2; pustules: 31-0; knots: 38-0.

Example 13: patient C. (n = 1), 24 years old, suffers from acne for 7 years, was previously treated with tetracycline per os for 3 months, Vidal's milk, opening of inflammatory elements without significant improvement. On examination: CTA IV (a = 4), localization of rashes on the face and trunk (c = 2), during a psychodiagnostic conversation, an asthenic-hypochondriacal symptom complex was formed that was formed under the influence of a cosmetic defect, but the patient agreed to follow all medical recommendations (e = 1 ), TIAM = 0.2. In accordance with the severity of skin lesions, Roaccutane therapy was prescribed for a period of 6 months. After 3 months, acne regressed by about 70%, the patient's mood background increased. Dynamics of rashes (before and after therapy, p <0.001): open comedones: 57-7; closed comedones: 62-10; papules: 44-2; pustules: 31-0; knots: 38-0. By the end of the treatment period, psychoemotional disorders completely regressed. Results of treatment: are presented in the generalized table 4.

Table 4
The effectiveness of various types of anti-acne therapy Group Type of therapy N Clinical
cure Significant
improvement Moderate
improvement abs. % abs. % abs. % 1A set of tools
medical cosmetics 39 28 71.8 7 eighteen 4 10,2 1B 0.1% gel or 0.1%
cream is adaptal 34 thirteen 38,2 eighteen 53 3 8.8 1B 0.1% gel or 0.1%
cream is adaptable in
combination with 1%
clinamycin gel
phosphate 24 eleven 45.8 thirteen 54,2 - - 1G 5% benzoyl gel
peroxide c
complex
acrylate
polymer and glycerin 26 22 84.6 4 15.4 - - 1D 0.1% gel or 0.1%
cream is adaptable in
combination with
tetracycline per
os nine 4 44.5 3 33.3 2 22.2 2A 0.035 mg
ethinyl estradiol with
2 mg cyproterone
acetate 44 eighteen 41 23 52,2 3 6.8 2B 0.03 mg
ethinyl estradiol with
2 mg dienogest eighteen 12 66.7 6 33.3 - - 3 isotretinoin per os 29th 29th 100 - - - - TOTAL 22
3 137 61,4 74 33,2 12 5,4

The method according to the invention offers a mathematical therapeutic index of Monakhov’s acne - TIAM, based on which, taking into account the patient’s gender, severity and prevalence of rashes, the presence of psycho-emotional disorders, a differentiated approach to the appointment of specific treatment regimens is carried out.

In the absence of psychoemotional disorders as a result of acne with initial skin changes (CTA I, any localization of acne) in both men and women (TIAM values 3, 4, 6, 7), it is advisable to treat with a complex of therapeutic cosmetics for at least three months with the subsequent transition to maintenance treatment with the means of this group with a frequency of use of 2-4 times a week indefinitely. The use of a complex of LC drugs makes it possible to achieve regression as non-inflammatory changes (open and closed comedones) due to keratolytic action, inflammatory changes (papules) due to anti-inflammatory and bacteriostatic effects and to reduce the effects of seborrhea (sebum adsorption and a moderate inhibitory effect on the function of the sebaceous glands).

Monotherapy with 0.1% gel or 0.1% cream of adapalene is indicated for women with STA II, when the process is limited by localization on the face (TIAM 11) and men with CTA II and with any prevalence of rashes (TIAM 10, 13).

Women with STA II and localization of the process both on the face and on the body (TIAM 14) should start therapy with 0.03 mg of ethinyl estradiol plus 2 mg of dienogest. This treatment regimen is justified by the etiopathogenetic effect of the drug on acne and the predominant effect on non-inflammatory elements during the first half of the course, and on inflammatory ones during the second half of treatment.

After the regression of papules and pustules (TIAM 3, 4, 6, 7), a transition to the treatment regimen with a complex of therapeutic cosmetics is necessary.

Combination therapy with 0.1% gel or 0.1% cream is adapted in combination with 1% clinamycin phosphate gel and is indicated for patients with STA III and localized acne on the face (TIAM 29, 30). This combination allows you to achieve a faster regression of inflammatory elements (primarily pustules). If there are indications that the patient in the past received anti-acne therapy with local or systemic antibiotics, then the therapy should be carried out with 5% benzoyl peroxide gel with a complex of acrylate co-polymer plus glycerin until the pustules disappear and the papules regress significantly (TIAM 10, 11), and then switch to monotherapy with 0.1% gel or 0.1% cream adapalene. Men with CTA III and localization of rashes on the face and trunk (TIAM 32) are shown therapy with 0.1% gel or 0.1% cream adapted in combination with tetracycline per os. The transition to monotherapy with 0.1% gel or 0.1% cream is adapted after regression of pustules and the majority of papules (TIAM 13).

Women with STA III and localization of the process on both the face and trunk (TIAM 35) should start therapy with 0.035 mg of ethinyl estradiol plus 2 mg of cyproterone acetate. This treatment regimen is justified by both the etiopathogenetic effect of the drug on acne and the predominant effect on inflammatory elements throughout the duration of treatment. In order to consolidate the results of therapy, 0.035 mg of ethinyl estradiol plus 2 mg of cyproterone acetate, depending on the STA and the prevalence of rashes, the transition to therapy with 0.03 mg of ethinyl estradiol plus 2 mg of dienogest (TIAM 14) or 0.1% gel or 0.1% adapalene cream is shown (TIAM 11), or a complex of medical cosmetics (TIAM 4, 7).

The course of therapy with isotretinoin per os is carried out with CTA IV, regardless of the prevalence of rashes and the patient's gender (TIAM 66, 67, 69, 70).

Patients with varying degrees of severity of PER (“e” = 1) due to acne, with TIAM values of 1.4; 1.5; 1.6; 1.7; 1.8 (patients with STA I-II) is advisable in parallel with dermatological treatment (in accordance with the values of “a”, “c” and “n” TIAM), the appointment of psychopharmacological drugs (“soft” antipsychotics, antidepressants), especially at the beginning of the course of therapy when the patient is at high risk of abandoning the intended treatment program or the patient is not initially configured for a delayed result of therapy. With TIAM values of 1 or 0.2, psychopharmacotherapy is not required, because with minimally expressed acne, PERs are not yet formed, and in severe forms, in most patients, PE adaptation to skin lesion, which forms over a long time of the disease, is noted.

For the convenience of using TIAM for the purpose of prescribing anti-acne therapy, we have developed a computer program and a ruler that simplify the process of choosing a patient management tactic.

Claims (1)

The method of choosing acne therapy, including an assessment of the severity of skin lesions, characterized in that it further determines the prevalence of the rash, the patient’s gender and the presence of psychoemotional disorders, then Monakhov’s therapeutic acne index is calculated by

where a is the severity of acne, with a = 1 for severity of acne I, a = 2 for severity of acne II, a = 3 for severity of acne III, a = 4 for severity of acne IV; c is the prevalence of acne rashes, with c = 1 when localizing a rash on the face, c = 2 when localizing a rash on the face and trunk; n is the gender of the patient, with n = 1 in men, n = 2 in women; e - psycho-emotional disorders, and e = 0 in the absence of psycho-emotional disorders and e = 1 in the presence of psycho-emotional disorders, and, in the absence of psycho-emotional disorders and an index value of 3, 4, 6, 7, a complex of therapeutic cosmetics is prescribed; with a value of 10, 11, 12 - 0.1% gel or 0.1% cream is adaptal; with a value of 14 - 0.03 mg of ethinyl estradion with 2 mg of dienogest; at a value of 29, 30 - 0.1% gel or 0.1% cream is adaptable in combination with 1% clinamycin phosphate gel or 5% benzoyl peroxide gel with the complex: acrylate co-polymer and glycerin; at a value of 32 - 0.1% gel or 0.1% cream is adapted in combination with tetracycline per os; with a value of 33 - 0.035 mg of ethinyl estradiol with 2 mg of cyproterone acetate; at a value of 66, 67, 69, 70 - isotretinoin per os; in the presence of psychoemotional disorders and an index value of 1.4; 1.5; 1.6; 1.7; 1.8 - mild antipsychotics or antidepressants are prescribed in parallel with dermatological treatment.