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Atopische Dermatitis und internistische Komorbiditäten

Atopic dermatitis and general medical comorbidities

  • Schwerpunkt: Dermatologie und Innere Medizin
  • Published:
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Zusammenfassung

Die atopische Dermatitis (AD) ist eine der häufigsten chronisch-entzündlichen Dermatosen. Gekennzeichnet ist sie durch juckende, ekzematöse Hauteffloreszenzen. Aufgrund nachweisbarer Zeichen einer systemischen Entzündung sowie neuer systemischer Therapieoptionen rückten in den letzten Jahren zunehmend Untersuchungen von internistischen Komorbiditäten bei moderater bis schwerer AD in den Fokus der Forschung. Dabei wurde zum einen an prospektiven Kohortenstudien das lange bekannte erhöhte Risiko für andere atopische Erkrankungen wie das allergische Asthma bronchiale bestätigt. Zum anderen wurde eine Assoziation mit anderen dermatologischen Erkrankungen mit autoimmunologischer Pathogenese wie der Alopecia areata oder der Vitiligo gezeigt. Darüber hinaus wurden in den letzten Jahren auch Studien publiziert, die ein erhöhtes Risiko für internistische Autoimmunerkrankungen wie chronisch-entzündliche Darmerkrankungen oder rheumatoide Arthritis zeigten. Daten zur AD, die die Hautkrankheit als kardiovaskulären Risikofaktor postulieren, müssen differenziert betrachtet werden: Lediglich in den USA zeigten Querschnittsstudien und Auswertungen von Krankenkassendaten einen Zusammenhang zwischen AD und kardiovaskulären Komorbiditäten. Dies ließ sich in deutschen, dänischen und kanadischen Studien mit großen Stichprobenzahlen bislang nicht bestätigen. Inwieweit unterschiedliche Coping-Strategien in den verschiedenen Ländern die Manifestation von kardiovaskulären Erkrankungen bei AD beeinflussen, ist zu diskutieren. Bezüglich internistisch-mikrobiologischer Komorbiditäten lässt sich bei AD insbesondere eine Suszeptibilität gegenüber viralen Infektionen aufzeigen.

Abstract

Atopic dermatitis (AD) is one of the most frequent chronic inflammatory skin diseases, characterized by pruritic eczematous lesions. Due to the fact that AD is accompanied by signs of systemic inflammation and that an increased number of novel systemic treatment options are currently emerging, research into general medical comorbidities in moderately to severely affected AD patients has received great impetus in recent years. These studies have confirmed an increased risk of atopic diseases such as allergic asthma in AD patients. Furthermore, an association between AD and dermatological diseases with autoimmune pathophysiology such as vitiligo and alopecia areata has been demonstrated. Moreover, several studies have revealed an increased risk for internal autoimmune diseases in AD patients, e.g. inflammatory bowel disease and rheumatoid arthritis. A differentiated view of the data on AD as a possible risk factor for cardiovascular disease is needed. Large cross-sectional studies in the US revealed a correlation between AD and cardiovascular comorbidities. This has not been confirmed as yet in large German, Danish and Canadian investigations. Whether diverse “coping” strategies in different countries can explain these variances remains to be discussed. In terms of microbial comorbidities, AD patients display a particular susceptibility to viral infections.

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  1. Klinik für Dermatologie, Allergologie und Venerologie, Abteilung für Immundermatologie und experimentelle Allergologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    S. Traidl &  T. Werfel

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S. Traidl und T. Werfel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen eine schriftliche Einwilligung vor.

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Traidl, S., Werfel, T. Atopische Dermatitis und internistische Komorbiditäten. Internist 60, 792–798 (2019). https://doi.org/10.1007/s00108-019-0633-4

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