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Aktinische Keratosen

Pathogenese, Klinik und moderne Therapieoptionen

Actinic keratoses

Pathogenesis, clinical aspect and modern therapeutic options

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Zusammenfassung

Aktinische Keratosen werden insbesondere bei Menschen über dem 50. Lebensjahr mit hellem Hauttyp in lichtexponierten Arealen festgestellt. In den letzten Jahren konnte ein deutlicher Anstieg der Prävalenz für aktinische Keratosen beobachtet werden. Als Hauptrisikofaktor gilt eine langjährige UV-Exposition (Freizeit, Outdoor-Berufe), die zu Mutationen im Tumorsuppressorgen TP53 und im Ras-Onkogen H-ras führt. In der Folge kommt es zu einer Proliferation atypischer Keratinozyten im Bereich der Epidermis. Werden multiple Herde über größere Areale UV-belasteter Haut sichtbar, spricht man von Feldkanzerisierung. Aktinische Keratosen bezeichnet man auch als Karzinome in situ, sie können mit einem Risiko von 6–10 % in ein Plattenepithelkarzinom übergehen. Um die Ausbildung von Plattenepithelkarzinomen zu vermeiden, sollte daher frühzeitig eine Behandlung der aktinischen Keratosen erfolgen. In den letzten Jahren hat sich eine Vielzahl an Therapiemöglichkeiten etabliert, wobei sich je nach klinischer Ausprägung läsions- oder feldgerichtete Therapieverfahren mit zum Teil sehr guten Ansprechraten und kosmetischen Ergebnissen bewährt haben.

Abstract

Actinic keratoses primarily affect fair-skinned individuals over 50 years of age. Due to demographic changes, the prevalence of actinic keratoses has increased over the last years. An established risk factor is chronic UV-exposure (outdoor workers) inducing mutations of the tumor suppressor gene TP53 and the oncogene H-ras. This leads to an intraepidermal proliferation of atypical keratinocytes. The term “field cancerization” characterizes the presentation of multiple actinic keratoses in UV-exposed areas. Actinic keratoses are also termed squamous cell carcinoma (SCC) in situ. The risk for actinic keratoses to turn into a SCC is 6–10 %. Treatment should be provided early in the disease course to avoid the possibility of invasive growth. In recent years, multiple therapeutic options have been established. Depending on the clinical extent, lesion- or field-directed therapies with excellent clinical response and cosmetic results are available.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Strunk hat als Prüfärztin an klinischen Studien im Indikationsgebiet der Firmen Almirall, Biofrontera, Galderma und Leo teilgenommen sowie Vortrags- und Beratungshonorare von Biofrontera und Galderma erhalten. R.-M. Szeimies hat als Prüfarzt an klinischen Studien im Indikationsgebiet der Firmen Almirall, Biofrontera, Galderma und Leo teilgenommen, von den genannten Firmen sowie meda und photonamic Vortrags- und Beraterhonorare erhalten und ist Mitglied in Advisory Boards von Almirall, Biofrontera, Galderma, Leo und photonamic. R.-M. Szeimies ist ferner an der Entwicklung eines ALA-haltigen Pflasters und einer LED-Lampe zur PDT beteiligt. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Behandlungszentrum Knappschaftskrankenhaus Recklinghausen, Klinik für Dermatologie und Allergologie, Klinikum Vest GmbH Recklinghausen, Dorstener Str. 151, 45657, Recklinghausen, Deutschland

    T. Strunk & R.-M. Szeimies

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Strunk, T., Szeimies, RM. Aktinische Keratosen. Hautarzt 65, 241–254 (2014). https://doi.org/10.1007/s00105-014-2759-6

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