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Der Hautarzt

, Volume 64, Issue 4, pp 263–268 | Cite as

Isotretinoin

Wie behandelt man richtig?
  • A. Thielitz
  • H. GollnickEmail author
Leitthema

Zusammenfassung

Isotretinoin repräsentiert seit über 30 Jahren das effektivste und nachhaltigste Medikament zur Therapie schwerer Akneformen und kann bei 70–80 % der Patienten nach 1-maliger Behandlung eine langfristige Remission erzielen. Neue Erkenntnisse zur Beeinflussung der angeborenen Immunität, der Modulation von Wachstumsfaktoren oder der zeitabhängigen Regulation von Genen der Entzündung und des Matrixstoffwechsels ermöglichen ein verbessertes Verständnis der Dynamik der Isotretinoin-Wirkung. Die neue evidenzbasierte europäische S3-Leitlinie empfiehlt erneut den Einsatz von Isotretinoin als First-line-Medikament zur Behandlung der Acne papulopustulosa nodosa oder conglobata, insbesondere wenn prognostisch ungünstige Faktoren wie positive Familienanamnese, früher Beginn, Hyperseborrhö, Lokalisation am Stamm, Vernarbung, psychische Beeinträchtigung oder eine (persistierende) Spättypakne vorliegen. Die Assoziation einer kumulativen Gesamtdosis von > 100–120 mg/kg mit einer niedrigeren Rückfallrate kann bei Patienten mit schweren Akneformen als etabliert angesehen werden, während für mildere Akneformen „off label“ auch mit niedrigeren Gesamtdosen gute klinische Langzeitergebnisse erzielt werden können.

Schlüsselwörter

Wirkmechanismus Kumulative Gesamtdosis Nebenwirkungen Rückfallrate Akne 

Isotretinoin

How should it be used?

Abstract

Isotretinoin has been the most effective and long-lasting drug for the treatment of severe acne for more than 30 years and can achieve long-term remission in 70–80 % of patients after a single course. New findings concerning its influence on innate immunity, the modulation of growth factors or the time-dependent regulation of genes of inflammation or matrix metabolism contribute to an improved understanding of the dynamic mode of action of isotretinoin. The new evidence-based European S3-guideline recommends the use of Isotretinoin as a first-line medication for the treatment of severe papulopustular or conglobate acne, especially when prognostically unfavorable factors are present: family history of acne, early onset, marked seborrhea, localization on the trunk, scarring, psychosocial disability or persistent/late-type acne. The correlation of a cumulative dose of > 100–120 mg/kg with a reduced relapse rate can be regarded as established in patients with severe acne forms, whereas in milder, “off-label”-treated acne forms, a good clinical outcome can also be achieved with lower cumulative doses.

Keywords

Mechanism of action Cumulative dose Side effects Relapse rate Acne 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seinen Koautor an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Universitätsklinik für Dermatologie und VenerologieOtto-von-Guericke UniversitätMagdeburgDeutschland
  2. 2.Dermatologisches Zentrum im Berufsgenossenschaftlichen Unfallkrankenhaus Hamburg-BergedorfHamburgDeutschland

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