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Moderne Antimykotika

Was der behandelnde Arzt darüber wissen sollte

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Zusammenfassung

Die Behandlung einer Mykose der Haut und ihrer Anhangsgebilde ist ein komplexer Vorgang, der von verschiedenen Faktoren des Antimykotikums, des Erregers und des Patienten beeinflusst wird. Neben der minimalen Hemmkonzentration (MHK) ist die Wirkstoffkonzentration im infizierten Gewebe für den Therapieerfolg entscheidend. Dermatophyten befinden sich oft in ihrer Dauerform als Arthrosporen in der Haut, in den Nägeln, hier oft in Hohlräumen, im bzw. am Haar. Diese ruhenden Pilze können von Antimykotika, deren Wirkung auf der Störung der Ergosterolsynthese beruht, nicht abgetötet werden, ebenso nicht Pilze in Hohlräumen, da kein Antimykotikum durch Luft diffundiert. Die Probleme bei der Behandlung der kindlichen Tinea capitis beruhen auf dem Unvermögen von Antimykotika, sich gleichmäßig im Haar auf seine gesamte Länge zu verteilen, auf dem Fehlen von Hauttalg, in dem Antimykotika konzentriert werden, und schließlich im Erreger, der sich im oder auf dem Haar überwiegend als nicht proliferierende Sporen befindet.

Abstract

The treatment of dermatophytoses is a complex process influenced by the properties of the antimycotic and the caustive agent as well as by patient-related factors. Both the minimal inhibition concentration and the drug concentration in the infected tissue influence treatment success. Dermatophytes can be present as arthrospores in the skin, nails or hair. Non-proliferating dermatophytes (arthrospores) are less susceptible to antimycotics than proliferating ones, particularly to antibiotics which act through the inhibition of fungal ergosterol synthesis. Non-proliferating dermatophytes do not syntheticize ergosterol, a essential component of fugal cell membranes. Also, dermatophytes accumulating in hollow spaces mostly in the nail plate, cannot be reached by antimycotics. The concentration of terbinafine and itraconazole is very high in sebum. This is of importance in the treatment of dermatophytoses localized to in the stratum corneum and in or around the hair. Preadolescent children do not have functioning sebaceous glands; this explains the difficulties in the treatment of pediatric tinea capitis.

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Interessenkonflikt:

Der korrespondierende Autor weist darauf hin, dass für alle Firmen, die die in diesem Artikel aufgeführten Antimykotika herstellen, gegen Honorar Leistungen von ihm in Form von Vorträgen, Publikationen u.ä. erbracht wurden.

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  1. Dresden

    C. Seebacher

  2. Merseburger Straße 5, 01309, Dresden

    C. Seebacher

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Seebacher, C. Moderne Antimykotika. Hautarzt 55, 150–157 (2004). https://doi.org/10.1007/s00105-003-0661-8

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