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Externatherapie des atopischen Ekzems im Kindesalter

Topical therapy of atopic dermatitis in children

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Zusammenfassung

Hintergrund

Das atopische Ekzem (AE) ist die häufigste chronisch-entzündliche Hauterkrankung des Kindesalters. Sie manifestiert sich in 60–80 % der Fälle bereits im 1. Lebensjahr. Die Pathogenese des AE ist durch ein Wechselspiel zwischen genetisch bedingten Faktoren (Barrieredefekt, überstarke kutane Entzündungsreaktion) und der sich daraus ergebenden Anfälligkeit für exogene Triggerfaktoren (Infekte, Allergene, „Stress“) gekennzeichnet.

Therapie

In jedem Stadium der Erkrankung ist die Barrieretherapie zentraler Bestandteil der Therapie des AE. Durch die Wiederherstellung der defekten Barriere wird dem erhöhten transepidermalen Wasserverlust entgegengewirkt und das Eindringen von Allergenen bzw. Erregern von außen, das den kutanen Entzündungsprozess fördert, vermindert oder unterbunden. Die Externatherapie sollte an Krankheitsstadium, Lokalisation, Jahreszeit und Alter des Kindes adaptiert sein. Die antiinflammatorische Lokaltherapie sollte nach dem Konzept der „proaktiven“ Therapie und mit „modernen“ topischen Kortikosteroiden (TCS) bzw. topischen Calcineurininhibitoren (TCI) erfolgen. Unter den TCS sind mittelstarke Wirkstoffe mit einem günstigen therapeutischen Index zu bevorzugen (Prednicarbat, Methylprednisolon). Langzeituntersuchungen zeigen ein sehr gutes Sicherheitsprofil der TCI, die für die Langzeitanwendung ideal sind.

Schlussfolgerung

Mit einer am Erkrankungsstadium und Alter des Kindes adaptierten Externatherapie lassen sich 90–95% der AE-Fälle gut beherrschen. Ziele der Behandlung sind die Kontrolle der Erkrankung und die Rezidivprophylaxe.

Abstract

Background

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in children. In 60–80 % of all cases it manifests during the first year of life. AD pathogenesis is characterized by an interplay between genetic disposition (barrier defect, excessive cutaneous inflammation) and an increased susceptibility to reacting to triggering factors (infections, allergens, “stress”).

Therapy

In every stage of the disease, barrier therapy is crucial. Restoration of the defective barrier prevents transepidermal water loss as well as intrusion of allergens and pathogens from outside that promote cutaneous inflammation. Topical barrier therapy should be adapted to the disease stage, the location of the eczema, the season, and the age of the child. Proactive topical anti-inflammatory therapy is based on “modern” topical corticosteroids (TCS) and topical calcineurin inhibitors (TCI). Among a wide selection of TCS, prednicarbate and methylprednisolone are preferred owing to their favorable safety/efficacy profile. According to recently published studies, the same applies to TCI, which are ideally suited for long-term therapy in order to prevent relapses.

Conclusion

A total of 90–95% of cases can be effectively controlled by topical therapy tailored to the disease state and patient age. Therapy aims at disease control and prevention of recurrences.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. P.H. Höger gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Zentrum für Kinder- und Jugendmedizin, Abt. Pädiatrie und Pädiatrische Dermatologie/Allergologie, Kath. Kinderkrankenhaus Wilhelmstift, Liliencronstr. 130, 22149, Hamburg, Deutschland

    P.H. Höger

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Höger, P. Externatherapie des atopischen Ekzems im Kindesalter. Monatsschr Kinderheilkd 163, 981–990 (2015). https://doi.org/10.1007/s00112-014-3168-8

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