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Der Hautarzt

, Volume 64, Issue 7, pp 494–499 | Cite as

Topische Therapie der Rosazea

  • H. SchöferEmail author
Leitthema

Zusammenfassung

Metronidazol- und azelainsäurehaltige Präparate sind die einzigen für die topische Therapie der Rosazea zugelassenen Externa. Alle anderen topischen Behandlungen der verschiedenen Rosazeastadien und ihrer Sonderformen erfolgen mit Fertigarzneimitteln und Magistralrezepturen im Off-label-Use. Kortikosteroidexterna gelten wegen ihrer unerwünschten Nebenwirkungen (erhöhtes Atrophierisiko der Gesichtshaut, Induktion einer Steroidrosazea, massive Verschlechterung des Hautbefundes nach dem Absetzen) als kontraindiziert. Sie dürfen lediglich bei schweren Akutformen (z. B. Rosacea fulminans) kurzzeitig zur Therapieeinleitung eingesetzt werden. Hauptindikation der topischen Behandlung ist die Rosacea papulopustulosa. Die Talgdrüsen- und Bindegewebshyperplasien der glandulär hyperplastischen Rosazea sind mit Externa kaum zu beeinflussen, und auch die flüchtigen Erytheme der Rosazeadiathese sowie die persistierenden Erytheme der Rosacea erythematosa sprechen auf topische Therapien nur unbefriedigend an. Für diese erythematösen Formen steht ein neuer Wirkstoff, der α2-Adrenorezeptor-Agonist Brimonidin, in einer Gelformulierung vor der Zulassung. Bei allen schweren Formen der Rosazea wird zunächst eine topisch systemische Kombinationstherapie empfohlen. Nach deutlicher Besserung reicht dann häufig eine topische Erhaltungstherapie zur Stabilisierung des Befundes aus.

Schlüsselwörter

Topische Behandlung Metronidazol Azelainsäure Brimonidin Rosazea 

Topical therapy of rosacea

Abstract

Metronidazole and azelaic acid are the only topical medications approved for rosacea. All other topical treatments for rosacea and its special forms are used off-label. Topical steroids are not indicated in rosacea, because of their side effects (induction of steroid rosacea, high risk of facial skin atrophy, and high risk of rebound after cessation of therapy). Topical as well as systemic steroids are allowed only as initial and short term therapy for acute forms of rosacea (e.g. rosacea fulminans). Papular and pustular rosacea is the major indication for topical therapy. Sebaceous gland and connective tissue hyperplasia in glandular-hypertrophic rosacea as well as erythema in erythematous rosacea do not respond well to topical measures. A new active substance, the alpha-2-adrenoreceptor agonist brimonidine, will be approved soon for the topical treatment of erythema in rosacea. All severe forms of rosacea should initially be treated with a combination of topical and systemic agents. After improvement of the clinical symptoms, topical treatment alone is usually adequate to maintain the control.

Keywords

Topical therapy Metronidazole Azelaic acid Brimonidine Rosacea 

Notes

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor berät die Firmen GSK-Stiefel, Galderma, Leo, Meda und Abbott in medizinisch dermatologischen Fragen und ist Mitglied des Rosacea Advisory Boards der Firma Galderma. Außerdem hält der Autor bezahlte Vorträge für die Firmen GSK-Stiefel, Galderma, Meda und Abbott.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Klinik für Dermatologie, Venerologie und AllergologieKlinikum der J.W. Goethe-UniversitätFrankfurt/MainDeutschland

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