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Antipruritische Wirkung von Pimecrolimus und Tacrolimus

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Zusammenfassung

In den letzten Jahren brachte die Einführung der topischen Calcineurininhibitoren eine deutliche Optimierung der Therapie von entzündlichen Hauterkrankungen, wie z. B. der atopischen Dermatitis, mit sich. Häufig war zusätzlich ein sehr guter antipruritischer Effekt zu beobachten. Mittlerweile wurden Pimecrolimus und Tacrolimus bei vielen mit Juckreiz einhergehenden Dermatosen wie dem chronisch-irritativen Handekzem, der Rosazea, "Graft-versus-Host"-Erkrankung, renalen Pruritus, LSA, Prurigo simplex, Prurigo nodularis, Skrotalekzemen und der inversen Psoriasis eingesetzt. Die antipruritische Wirkung beruht möglicherweise auf der Hemmung von inflammatorischen Zytokinen. Darüber hinaus gibt es Hinweise dafür, dass Pimecrolimus und Tacrolimus ähnlich wie Capsaicin an den Nervenfasern eine Ausschleusung der Neuropeptide mit nachfolgender Mastzelldegranulation bewirken. Dadurch ließen sich einerseits die initialen Nebenwirkungen der Therapie wie Brennen und Pruritus erklären. Zum anderen bieten die Befunde einen weiteren Erklärungsansatz für die antipruritogene Potenz beider Substanzen, die durch direkte Wirkung an den sensorischen Nervenfasern über bislang ungeklärte Mechanismen vermittelt werden könnte.

Abstract

The development of topical calcineurin inhibitors resulted in a significant improvement in the treatment of inflammatory skin diseases such as atopic dermatitis. In addition, an excellent amelioration of pruritus could be observed. Other itchy dermatoses such as chronic irritative hand dermatitis, rosacea, graft-versus-host-disease, renal pruritus, lichen sclerosus, prurigo simplex, prurigo nodularis, scrotal eczema, and inverse psoriasis also have been treated successfully with pimecrolimus and tacrolimus. The antipruritic effect currently is believed to be related to the inhibition of inflammatory cytokines. Furthermore, recent investigations indicate a release of neuropeptides from sensory nerve fibers and degranulation of mast cells mediated by pimecrolimus and tacrolimus. Similar effects have been observed during capsaicin treatment. These findings may provide a possible explanation for initially observed calcineurin inhibitors related side-effects such as burning and pruritus. Moreover, the antipruritic potency may be related to a direct effect on nerve fibers leading to suppression of itch mediated by unknown mechanisms.

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Authors and Affiliations

  1. Klinik und Poliklinik für Hautkrankheiten, Universitätsklinikum Münster

    S. Ständer & T. A. Luger

  2. Klinik und Poliklinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarchstraße 58, 48149 , Münster

    S. Ständer

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  1. S. Ständer
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  2. T. A. Luger
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Correspondence to S. Ständer.

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Ständer, S., Luger, T.A. Antipruritische Wirkung von Pimecrolimus und Tacrolimus. Hautarzt 54, 413–417 (2003). https://doi.org/10.1007/s00105-003-0521-6

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  • DOI: https://doi.org/10.1007/s00105-003-0521-6

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