Zusammenfassung
Die Psoriasis ist mit einer Prävalenz von 2 %
eine der häufigsten Hautkrankheiten mit einer großen medizinischen,
aber auch einer enormen psychosozialen und gesundheitsökonomischen
Bedeutung. Insbesondere für Patienten mit schweren Psoriasis-Formen sowie
mit Psoriasisarthritis waren die Therapieoptionen bis Ende des vergangenen
Jahrhunderts häufig unbefriedigend. Dies änderte sich schlagartig mit
der genaueren Aufklärung der Pathogenese, die zu einer Etablierung der
Psoriasis als Modellbeispiel für TH1-vermittelte
chronisch-entzündliche Erkrankungen führte und die eine
Einführung von Biologicals in die Psoriasistherapie ermöglichte.
Neben den bisher zugelassenen TNF-α-Antagonisten und dem
LFA-1-Antikörper Efalizumab befinden sich derzeit vielversprechende neue
Biologicals in der Entwicklung und klinischen Prüfung, insbesondere
Antikörper gegen die gemeinsame p40-Proteinuntereinheit von Interleukin 12
und 23. Solche IL12/23-p40-Antikörper hemmen nicht nur die Differenzierung
zu TH1-Zellen, sondern auch die Entstehung von
TH17-Zellen, einem neu entdeckten, für die Pathogenese der
Psoriasis bedeutsamen Typ von T-Zellen. Das Krankheitsbild Psoriasis erscheint
daher heute für Forscher sowie für Kliniker spannender als je zuvor.
In den letzten Jahren wurde zudem deutlich, dass Psoriasis-Patienten ein
wesentlich erhöhtes Risiko für kardiovaskuläre und metabolische
Erkrankungen besitzen. Diese Erkenntnis trug zu einem Paradigmenwechsel bei,
nach dem die Psoriasis heute nicht mehr als haut- und gelenkspezifische
Krankheit, sondern als Multisystemerkrankung betrachtet wird. Eine neue Aufgabe
der Dermatologen ist nunmehr, insbesondere für Risikopatienten geeignete
Screening-Untersuchungen zu veranlassen.
Abstract
Psoriasis is, with a prevalence of 2 %, one of the
most frequent dermatological diseases with a great medical, but also an
enormous psychosocial and health economic impact. Until the end of the last
century, therapeutic options were often dissatisfactory, in particular for
patients with severe forms of psoriasis and with psoriatic arthritis. This
changed abruptly when the pathogenesis was elucidated more precisely, leading
to an establishment of psoriasis as a model example of TH1-mediated
chronic inflammatory diseases and allowing the introduction of biologicals into
antipsoriatic therapy. In addition to the TNF-α antagonists and the LFA-1
antibody efalizumab approved at present, promising new biologicals are
currently being developed and evaluated in clinical trials, especially
antibodies against the common p40 protein subunit of interleukin 12 and 23.
Such IL12/23-p40 antibodies inhibit the differentiation into TH1
cells, but also the development of TH17 cells, a newly discovered
type of T cells with great importance for the pathogenesis of psoriasis. Today
psoriasis appears as a more exciting disease than ever before, both for
researchers and for clinicians.
Moreover, it has become evident during the last years that patients
with psoriasis have a substantially increased risk for cardiovascular and
metabolic diseases. This contributed to a change of paradigm, after which
psoriasis has to be considered no longer as a skin- and joint-specific disease,
but as a multisystem disorder. Hence, a new task for dermatologists is to
arrange suitable screening examinations, particularly for high risk
patients.
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PD Dr. med. Wiebke Ludwig-Peitsch
Klinik für Dermatologie, Venerologie und
Allergologie
Universitätsmedizin
Mannheim
Universität Heidelberg
Theodor-Kutzer-Ufer 1–3
68135 Mannheim
eMail: wiebke.ludwig@haut.ma.uni-heidelberg.de
