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Aktuelle Dermatologie 2006; 32(5): 190-200
DOI: 10.1055/s-2006-925353
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Klassische systemische Therapie der Psoriasis

Classical Systemic Therapy of PsoriasisW.  K.  Ludwig-Peitsch1 , N.  Kemmler1 , S.  Goerdt1 , M.  Goebeler1
  • 1Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Mannheim, Universität Heidelberg
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Publication History

Publication Date:
18 May 2006 (online)

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Zusammenfassung

Zur Therapie von schweren Psoriasis-Formen und der Psoriasisarthritis stehen eine Reihe klassischer Systemtherapeutika zur Verfügung, darunter Fumarsäure, Acitretin, Methotrexat und Ciclosporin. Daneben ist Leflunomid in Deutschland für die Psoriasisarthritis zugelassen; kasuistisch und im Rahmen kleinerer Studien wurde auch Mycophenolat-Mofetil erfolgreich eingesetzt. Nach Einführung der Biologicals wird zunehmend eine Neubewertung der klassischen Antipsoriatika und ihres Stellenwerts in der Psoriasistherapie gefordert. Diese Arbeit gibt einen Überblick über Einsatzmöglichkeiten, Effektivität und Sicherheitsprofil der klassischen Systemtherapeutika der Psoriasis und möglicher Kombinationen. Da die Psoriasis eine oft über mehrere Jahrzehnte chronisch verlaufende Erkrankung ist, bedarf es eines langfristigen Therapiekonzepts unter Berücksichtigung der Langzeit-Risiken und kumulativen Toxizitäten. Zur Reduktion solcher Risiken bietet sich oftmals der sequenzielle oder rotierende Einsatz der verschiedenen Systemtherapeutika an. In diesem Zusammenhang werden die Biologicals in Zukunft noch stärker als heute eine Rolle spielen; ob sie die klassischen Antipsoriatika ersetzen können werden, ist heute noch nicht absehbar.

Abstract

For therapy of severe psoriasis and psoriatic arthritis, a number of classical systemic therapeutics are available that include fumaric acid, acitretin, MTX and cyclosporine. In addition, leflunomide has been approved for the treatment of psoriatic arthritis. Moreover, casuistically and in the context of small studies, mycophenolate mofetil has been applied successfully. After the introduction of biologicals, there is an increasing demand for re-evaluating the classical systemic antipsoriatics and reappraising their value for psoriasis therapy. This article gives a survey of their efficiency, their safety profile and possible combinations. As psoriasis is a chronic disease often affecting the patients over many decades, a long-term therapy concept considering long-run risks and cumulative toxicities is required. To reduce such risks, a sequential or rotating application of the diverse systemic medications often appears suitable. In this context, biologicals will gain a greater role in the future than today, but presumably will not completely replace the classical antipsoriatics.

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Prof. Dr. med. Matthias Goebeler

Klinik für Dermatologie, Venerologie und Allergologie · Universitätsklinikum Mannheim · Universität Heidelberg

Theodor-Kutzer-Ufer 1 - 3 · 68135 Mannheim

Email: matthias.goebeler@haut.ma.uni-heidelberg.de