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Aktuelle Dermatologie 2003; 29(8/09): 327-334
DOI: 10.1055/s-2003-41990
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Behandlung des atopischen Ekzems mit topischen Calcineurininhibitoren

Treatment of Atopic Eczema with Topical Calcineurin InhibitorsT.  A.  Luger1
  • 1 Klinik und Poliklinik für Hautkrankheiten, Universitätsklinikum Münster
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Publication History

Publication Date:
16 September 2003 (online)

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Zusammenfassung

In den letzten Jahren hat es wie noch nie zuvor in der gesamten Medizin und damit auch in der Dermatologie derart spannende und viel versprechende Entwicklungen in der Therapie gegeben. Ein entscheidender Fortschritt im therapeutischen Arsenal bei der Behandlung des atopischen Ekzems stellen die neuen topischen Calcineurininhibitoren wie Tacrolimus und Pimecrolimus dar. Beide Therapeutika Tacrolimus Salbe (Protopic) und Pimecrolimus Creme (Elidel) sind für die Behandlung des atopischen Ekzems zugelassen. Seit Einführung der topischen Kortikosteroide vor mehr als 50 Jahren stellt dies die erste wirkliche Innovation in der topischen Therapie dar und füllt damit eine große therapeutische Lücke. Beide Substanzen sind entzündungshemmend wirksam und insbesondere Pimecrolimus besitzt nur ein schwaches immunsuppressives Potenzial. Beide Lokaltherapeutika sind bis auf ein vor allem bei Protopic auftretendes kurzfristiges Brennen gut verträglich und auch bei langfristiger Anwendung frei von kortikosteroidtypischen Nebenwirkungen wie Hautatrophie. Die nach lokaler Anwendung mögliche systemische Exposition ist relativ gering und insbesondere bei Pimecrolimus konnten in keinem Fall potenziell toxische Konzentrationen im Blut gemessen werden. Sowohl Protopic Salbe als Elidel Creme haben sich in Kurzzeit- und Langzeitstudien als sehr wirkungsvoll bei der Behandlung des atopischen Ekzems von Kindern und Erwachsenen erwiesen. Im Allgemeinen kommt es innerhalb von wenigen Tagen zu einer deutlichen Besserung der klinischen Symptomatik wie Juckreiz und Ekzem. Erste Beobachtungen belegen auch eine gute Wirksamkeit von topischen Calcineurininhibitoren bei der Behandlung von anderen entzündlichen Dermatosen. Inwieweit bei Patienten mit atopischen Ekzem eine prophylaktische Anwendung von Protopic oder Elidel und damit die Vermeidung eines chronischen Krankheitsverlaufes möglich ist, werden weitere klinische Studien zeigen.

Abstract

During the last years the enormous progress in the understanding of the complex pathomechanisms underlying immune-mediated and inflammatory skin diseases has allowed for the development of novel therapeutic strategies. Among several drugs and biologics being investigated for dermatological use currently calcineurin inhibitors such as tacrolimus and pimecrolimus appear to be the most promising. Recently topical preparations of both tacrolimus (Protopic) and pimecrolimus (Elidel) have been developed and are available for the treatment of atopic dermatitis. Since the introduction of topical corticosteroids more than 50 years ago these novel compounds are the first major development in the topical treatment of inflammatory skin diseases. Both drugs exert a potent antiinflammatory activity and the immunosuppressive potential of pimecrolimus in particular is minimal. Both compounds are well tolerated, do not cause skin atrophy and are safe during long-term application. Application site adverse events mainly consist of a transient sensation of burning which more frequently has been observed after the use of Protopic. The risk of systemic exposure after topical application is low and usually transient. In most of the cases blood levels were below the limit of quantification and in particular Pimecrolimus blood levels never reached a range of potential toxicity. In many short- and long-term studies Protopic-ointment as well as Elidel-cream has been shown to be highly effective. The symptoms of atopic dermatitis such as pruritus and eczema were found to improve within a few days. According to first reports both Protopic and Elidel also appear to be highly effective in the treatment of other inflammatory skin diseases. Future studies will reveal whether early and perhaps prophylactic application of topical calcineurin-inhibitors may prevent flare progression and improve long-term disease control.

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Prof. Dr. med. T. A. Luger

Universitäts-Hautklinik Münster

Von-Esmarch-Straße 56 · 48149 Münster ·

Email: luger@uni-muenster.de

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