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Probiotische Externa

Outside-in

Probiotic topical agents

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Zusammenfassung

Der Einsatz von probiotischen Mikroorganismen, meist peroral appliziert, wurde in der Dermatologie zur Prophylaxe und Therapie atopischer Erkrankungen untersucht. Im Gegensatz zu erfolgreichen Therapieansätzen für Erkrankungen des Gastrointestinaltraktes konnten nur in einzelnen Studien positive Effekte für die atopische Dermatitis gefunden werden. Neuere Erkenntnisse könnten nun den Stellenwert von Probiotika für die Dermatologie grundlegend verändern: Probiotika sind – wie die Mikroflora der Haut – nichtpathogene Keime, die auf der Haut keine Entzündungsreaktionen auslösen. Im Sinne einer effektiven therapeutischen Nutzung werden die Gemeinsamkeiten von Probiotika, nichtpathogenen Keimen und Mikroflora derzeit charakterisiert: Diese Keime entfalten einen Großteil ihrer Wirkung zunächst direkt am Ort der Anwendung und induzieren damit natürliche Abwehrmechanismen gegenüber Pathogenen. Ein ebenso wichtiger Wirkmechanismus ist die Förderung der immunologischen Toleranz. Die zugrunde liegenden Mechanismen für die Toleranz der Standortflora auf Oberflächenorganen haben sich evolutionär entwickelt und sind damit vielfältig. Daher ist der topische Einsatz von Probiotika und nichtpathogenen Keimen zur Prophylaxe und Therapie überschießender kutaner entzündlicher Immunreaktionen sehr vielversprechend. Erste Ergebnisse aus klinischen Studien konnten die Wirksamkeit dieses neuen Therapiekonzeptes bereits belegen.

Abstract

In dermatology probiotic microorganisms have primarily been used orally for the prophylaxis and treatment of atopic disorders. In contrast to the successes achieved for gastrointestinal disorders, positive effects for atopic dermatitis only have been found in a few studies. New insights could now fundamentally change the impact of probiotics on dermatology. Probiotics are – like microflora of the skin – non-pathogenic microbes, which do not induce inflammatory responses in the skin. Common pathways for probiotics, non-pathogenic microbes, and microflora are characterized, in order to facilitate their more effective therapeutic use. These microbes display a majority of their effects directly at the site of application and thereby induce natural defense mechanisms. However, promotion of immunological tolerance is just as important in producing positive effects. Tolerance of the resident flora on surface organs developed during evolution and the mechanisms of action are multifaceted. Therefore, the topical application of probiotics and non-pathogenic microbes for prophylaxis and therapy of overwhelming cutaneous pro-inflammatory immune reactions is very promising. Results of recent clinical trials already have demonstrated the efficacy of this new therapeutic concept.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Die Studien zu V. filiformis wurden von L’Oréal Recherche unterstützt.

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  1. Universitäts-Hautklinik Tübingen, Liebermeisterstr. 25, 72076, Tübingen, Deutschland

    T. Volz &  T. Biedermann

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  1. T. Volz
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  2. T. Biedermann
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Correspondence to T. Biedermann.

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Volz, T., Biedermann, T. Outside-in. Hautarzt 60, 795–801 (2009). https://doi.org/10.1007/s00105-009-1755-8

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