Atopische Keratokonjunktivitis: Pathophysiologie, Klinik und potenzielle neue Therapiekonzepte

Zusammenfassung

Die atopische Dermatitis (AD) ist eine chronisch rezidivierende inflammatorische Hauterkrankung, die mit einer 2-gipfligen Altersverteilung sowohl im Kindes- und Jugendalter als auch im mittleren Erwachsenenalter auftritt. In bis zu 50% der AD-Patient*innen findet sich eine Augenbeteiligung, die potenziell visusbedrohend verlaufen kann. Klinisch zeigt sich in der Mehrzahl der Fälle eine atopische Blepharo(kerato)konjunktivitis (ABK) bzw. atopische Keratokonjunktivitis (engl. AKC); weitere klinische Varianten aus diesem Formenkreis der entzündlichen Augenoberflächenerkrankungen sind die Keratoconjunctivitis vernalis im Kindes- bzw. Jugendalter und die allergische Konjunktivitis. Neben der bereits erwähnten Blepharitis, Keratitis und Konjunktivitis sind bei der AD auch eine Lidbeteiligung mit konsekutiver Lidfehlstellung, einer Limbusinsuffizienz mit Ausbildung von Pseudopterygien, eine vernarbende Konjunktivitis mit Symblephara und Fornixverkürzung sowie Malignome der Augenoberfläche wie konjunktivale intraepitheliale Neoplasien (CIN) und Plattenepithelkarzinome beschrieben. Zudem ist für den Keratokonus eine Assoziation mit der AD bzw. der AKC beschrieben. Während sich die Therapie der AD in der Dermatologie durch den Einsatz von Biologika in den letzten Jahren revolutionär weiterentwickelt hat, erfolgt der primäre Einsatz dieser Biologika bei ophthalmologischen Komplikationen noch sehr zurückhaltend. Die Behandlung erfolgt hier häufig mit Steroiden und Calcineurin-Inhibitoren in topischer Form. Der folgende Artikel fasst neuere Entwicklungen aus der dermatologischen Grundlagenforschung und der klinischen Forschung zusammen und beleuchtet diese im Kontext aktueller ophthalmologischer Therapiekonzepte.

Conclusion

Dermatological Conclusion

• AD is widespread, especially in developed countries, affecting up to 25% of children and 10% of adults.

• Genetically determined skin barrier defects predispose affected individuals to inflammation and consecutive superinfections (in particular with Staphylococcus aureus).

• The localization and symptoms vary depending on age and include severe itching, erythema, and lichenification.

• Standard treatment includes basic therapy and topical immunomodulators.

• A variety of new systemic immunomodulators are now available for diseases stages that do not respond to topical treatment.

Ophthalmological Conclusion

• Involvement of the ocular surface and periocular adnexa in the form of AKC is very common in AD patients, occurring in over 50% of cases.

• If left untreated, AKC can lead to loss of vision.

• Treatment depends on the ophthalmological findings – if topical steroids and topical CsA are insufficient, an appropriate systemic treatment must be evaluated in consultation with the treating dermatologist.

Future developments in pharmacotherapy give cause to hope that the spectrum of available topical drugs will be expanded.

Schlüsselwörter

Atopie - atopische Dermatitis - Neurodermitis - Keratoconjunctivitis vernalis - atopische Keratokonjunktivitis

Publication History

Received: 29 October 2023

Accepted: 08 January 2024

Article published online:
11 April 2024

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