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Rosazea

Klinik, Pathogenese, Therapie

Rosacea

Clinical features, pathogenesis and therapy

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Zusammenfassung

Die Rosazea ist eine häufige Gesichtsdermatose, die die Patienten stark psychosozial einzuschränken vermag. Sie ist eine Erkrankung des mittleren Lebensalters, in Europa kommt sie häufiger in nördlichen Landern (England, Skandinavien) vor, Hauttyp I und II sind ebenso häufiger als Hauttyp IV–VI befallen. Klinisch werden ein Vorstadium sowie die Stadien I–III unterschieden. Das Vorstadium ist durch eine Flushsymptomatik gekennzeicnet, die weiteren Stadien durch Teleangiektasien, Papulopusteln und entzündliche Knoten (Grad III). Besonders schwere Formen sind die Rosacea fulminans und die Rosacea conglobata. Die Hyperglandulären Formen führen zu Gewebsvermehrungen, den Phymen, am häufgsten ist das Rhinophym. Pathogenetisch werden verschiedenartige Störungen der dermalen Gefäße und des Bindegewebes diskutiert. Bei genetisch determinierter Prädisposition führen Provokationsfaktoren zu Gefäß- und Bindegewebsschäden. Konsekutiv führt eine chronische Entzündungsreaktion zum Phänotyp der Rosazea in ihren verschiedenen Ausprägungsformen. Milde Formen werden topisch behandelt. Für Antibiotika (Erythromycin, Clindamycin, Tetrazykline), Metronidazol, Azelainsäure und das Retinoid Adapalene liegen doppelblinde, randomisiert kontrollierte Studien vor. Schwere Formen erfordern eine systemische Therapie. Neben Antibiotika ist insbesondere Isotretinoin in verschiedener Dosierung sehr gut wirksam. Das Rhinophym muss operativ behandelt werden.

Abstract

Rosacea is a common facial dermatosis, which may have detrimental effects on the patient’s psychological and social interactions. It is a disease of the middle aged, skin types I and II are more often affected than darker skin types. Clinically, pre-rosacea, and rosacea grade I-III may be distinguished. Pre-rosacea is characterized by flushing and blushing, grade I to III by erythemato-teleangiectasies, papulopustules, and inflammatory nodules. Especially severe subtypes include rosacea conglobata and rosacea fulminans. Hyperglandular subtypes lead to different forms of phyma, of which Rhinophyma is the most frequent. Pathogenetically destruction of the dermal vessels and connective tissue seems to be decisive for the development of a chronic inflammation, which leads to the phenotype of the various forms of rosacea. Mild forms can be treated exclusively by topical medication. Antibiotics (erythromycin, clindamycin, tetracyclin), metronidazol, azelaic acid, and the retinoid adapalene have been shown to be effective in well controlled randomized studies. The best evaluated topical medication is metronidazol. In severe forms sytemic therapy must be applied. Systemic antibiotics are effective and especially isotretinoin has shown a very good response even in low dose regimens. Rhinophyma must be treated surgically.

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  1. Klinik für Dermatologie, Allergologie und Umweltmedizin, HELIOS-Klinikum Wuppertal, Universität Witten-Herdecke, Wuppertal

    P. Lehmann

  2. Klinik für Dermatologie, Allergologie und Umweltmedizin, HELIOS-Klinikum Wuppertal, Universität Witten-Herdecke, Heusnerstraße 40, 42283 , Wuppertal

    P. Lehmann

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Lehmann, P. Rosazea. Hautarzt 56, 871–887 (2005). https://doi.org/10.1007/s00105-005-1009-3

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