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Aktuelle Dermatologie 2003; 29(1/2): 49-57
DOI: 10.1055/s-2003-38236
Ästhetische Dermatologie
© Georg Thieme Verlag Stuttgart · New York

Moderne Aknetherapie

Modern Acne TreatmentCh.  C.  Zouboulis1
  • 1Klinik und Poliklinik für Dermatologie, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin
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Publikationsverlauf

Publikationsdatum:
27. März 2003 (online)

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Zusammenfassung

Akne ist die häufigste dermatologische Erkrankung: Rund 70 - 87 % aller Jugendlichen weisen Akneläsionen auf, 10 - 30 % davon benötigen eine medikamentöse Therapie. Bei der Mehrzahl der Patienten erfolgt nach der Pubertät eine spontane Rückbildung, davon 2 - 7 % mit erheblicher Narbenbildung. In 10 % der Fälle persistiert die Erkrankung über das 25. Lebensjahr hinaus. Die Auswahl eines Behandlungsschemas ist von der exakten Klassifikation der Akne und der Einordnung des Schweregrades abhängig. Insbesondere stellt die Entwicklung von Narben das Hauptkriterium für die Wahl einer systemischen Therapie dar. Retinoide für die nicht-entzündlichen und Benzoylperoxid für die entzündlichen Akneläsionen sind die Medikamente der ersten Wahl für eine topische Aknetherapie, wobei die Azelainsäure für milde Akneformen und zur Erhaltung eines Therapierfolges geeignet ist. Die Anwendung topischer Antibiotika nimmt - insbesondere aufgrund der Entwicklung resistenter Bakterienstämme durch ihren Einsatz - kontinuierlich ab. Bei der topischen Therapie spielt die Wahl der Grundlage eine übergeordnete Rolle. Antibiotika, Antiandrogene - in der Form von hormonellen Kontrazeptiva - und Isotretinoin sind die aktuellen Pfeiler der systemischen Aknetherapie. Kortikosteroide werden bei der Therapie der Acne fulminans, niedrig dosiert auch bei der Behandlung von Patienten mit adrenalem Hypergonadismus eingesetzt. Aktuelle neue Entwicklungen könnten interessante Perspektiven in der zukünftigen Therapie der Akne anbieten.

Abstract

Acne is the most common skin disease with a prevalence of 70 - 87% in adolescents. Ten to 30% of the individuals involved require medical treatment. The majority of patients experiences a spontaneous resolution of the disease after puberty, however in 2-7% the lesions heal with significant scarring. Ten percent of the patients exhibit persistence of their lesions over the age of 25 years. The selection of a therapeutic regimen is dependent on the classification type of acne and its severity grade. In particular, the major criterium leading to the decision for a systemic treatment is the development of scars. Retinoids and benzoyl peroxide are first choice topical drugs for the non inflammatory and the inflammatory lesions, respectively. Azelaic acid is only recommended for mild acne lesions and for the preservation of a successful therapeutic result obtained by another regimen. The application of topical antibiotics is continuously reduced, especially due to the development of resistant bacterial strains. The type of the vehicle is essential for the effectiveness of the topical treatment. Antibiotics, antiandrogens (in hormonal contraceptive preparations), and isotretinoin are the milestones of systemic acne treatment. Corticosteroids are administered in acne fulminans, also as low dose regimen in acne patients with adrenal hypergonadism. Currently, new developments offer interesting perspectives for the future acne treatment.

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Prof. Dr. med. Christos C. Zouboulis

Klinik und Poliklinik für Dermatologie · Universitätsklinikum Benjamin Franklin · Freie Universität Berlin

Fabeckstraße 60 - 62 · 14195 Berlin ·

eMail: zouboulis@medizin.fu-berlin.de