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Klinische Erfahrungen mit topischen Calcineurininhibitoren in der Praxis

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Zusammenfassung

Die klinischen Erfahrungen mit den topischen Calcineurininhibitoren in der Praxis sind im Vergleich zu den Kenntnissen mit Kortikosteroiden noch rudimentär, insbesondere im Hinblick auf die langfristige Verträglichkeit. Die systemische Absorption über die Haut bei der Behandlung des atopischen Ekzems ist aufgrund der mit der unter Therapie einhergehenden Regeneration der Hautbarriere unbedenklich. Bei andauernden Funktionsstörungen der Hautbarriere, wie man sie z. B. bei Genodermatosen, aber auch bei ausbleibendem Therapieerfolg findet, kann es jedoch zu systemisch relevanten Blutspiegeln kommen. Nebenwirkungen der topischen Calcineurininhibitoren lassen sich in lokale Intoleranzreaktionen und Hautinfektionen einteilen. Während das typische Brennen der Haut vorübergehender Natur ist, bleibt die seltenere lokale Intoleranzreaktion auf Alkohol während der Behandlungszeit bestehen. Bei den Hautinfektionen ist vor allem das Eczema herpeticatum zu erwähnen; das an sich schon geringe Risiko dieser Komplikation kann mit entsprechenden präventiven Maßnahmen noch gesenkt werden. Das klinische Profil der beiden topischen Calcineurininhibitoren unterscheidet sich bezüglich Wirkungsstärke, lokaler Toleranz, und galenischer Zubereitung, was die therapeutische Breite der Substanzklasse in der Praxis vergrößert.

Abstract

The clinical experience with topical calcineurin inhibitors in the field is still rudimentary, if compared to our knowledge of topical corticosteroids. This is especially true for the long-term effects. The systemic transcutaneous absorption that occurs during the therapy of atopic dermatitis is quantitatively irrelevant. However, in the setting of permanent disruption of the skin barrier, as may be encountered in rare Genodermatoses, but as well in cases that do not respond to therapy, continued treatment my result in clinically relevant blood levels. Side effects of topical calcineurin inhibitors may be separated into two groups, i.e. local intolerance reactions, and skin infections. While the typical burning sensation of the newly treated skin is ephemeral, local alcohol intolerance, albeit less frequent, will persist throughout the treatment period. Regarding skin infections, Eczema herpeticatum seems to be the only serious complication; adequate preventive will further reduce the risk of this rare complication.

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Notes

  1. Vortrag Dr. S. Reitamo, EADV spring conference, Malta, 2003.

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Authors and Affiliations

  1. Klinik und Poliklinik für Dermatologie und Venerologie, Hôpital Cantonal Universitaire, Genf, Schweiz

    J. Lübbe

  2. Clinique et policlinique de dermatologie et vénéréologie, Hôpital cantonal universitaire, 1211 , Genève 14, Schweiz

    J. Lübbe

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Lübbe, J. Klinische Erfahrungen mit topischen Calcineurininhibitoren in der Praxis. Hautarzt 54, 432–439 (2003). https://doi.org/10.1007/s00105-003-0527-0

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