Dermatologische Aspekte der Psoriasis 2010

Zusammenfassung

Die Schuppenflechte, eine chronisch-entzündliche Dermatose, betrifft zwei bis drei Prozent der kaukasischen Bevölkerung. Sie ist durch scharf begrenzte erythematöse Plaques mit silbrigweißer Schuppung gekennzeichnet. 20 bis 30 Prozent der Patienten sind zusätzlich an einer Psoriasis-Arthritis erkrankt. In den vergangenen Jahren gilt die Aufmerksamkeit zunehmend den bei Schuppenflechte gehäuft auftretenden Komorbiditäten, wie Herz-Kreislauferkrankungen, Diabetes mellitus und Übergewicht. Die Therapie der Psoriasis muss individuell an die jeweilige Schwere und Aktivität der Erkrankung angepasst werden. Leichtere Formen können oft mit einer Lokal therapie beherrscht werden, hierbei gilt es, Besonderheiten der verschiedenen anatomischen Regionen zu berücksichtigen. In der topischen Therapie werden neben den „klassischen“ Antipsoriatika wie Cignolin, die v. a. im stationären Bereich Anwendung finden, heute überwiegend Vitamin-D-Analoga und Kortikosteroide eingesetzt. Die Phototherapie zeigt gute Wirksamkeit, ist aber mit hohem zeitlichem Aufwand verbunden. Moderaten und v. a. schweren Formen sind die Systemtherapien vorbehalten. Die „konventionellen“ Systemtherapien wie Methotrexat, CSA, Retinoide und Fumarsäureester sind in den vergangenen Jahren durch die Biologika (Etanercept, Adalimumab, Infliximab, Ustekinumab) ergänzt worden. Bei der Auswahl der Systemtherapien müssen die Komorbiditäten und Komedikation der Patienten Beachtung finden. Gerade bei Psoriasis-Arthritis ist eine interdisziplinäre Zusammenarbeit zwingend notwendig.

Summary

Psoriasis, a chronic-inflammatory skin disorder, affects about 2–3 % of Caucasians. It’s characterized by erythematous plaques with silvery scaling. 20–30 % of psoriatic patients may also present psoriatic arthritis. Recently, more attention has been paid to the co-morbidities of psoriatic patients, e. g. cardiovascular diseases, diabetes mellitus and obesity. An individual therapeutic approach should encounter actual severity and disease activity. Mild forms respond usually sufficiently to topical therapies. Beside “classical” topical antipsoriatic drugs, such as Dithranol, used mainly in hospitalized patients, nowadays most patients are treated topically with vitamin D analogue and corticosteroids. Phototherapy is effective, but also time consuming. Moderate and especially severe psoriasis have a need for systemic drugs. In addition to the traditional antipsoriatic drugs such as MTX, CSA, retinoids and fumaric acid esters, biologics (etanercept, adalimumab, infliximab, ustekinumab) are available. Co-morbidities and co-medications must be considered when choosing a systemic therapy. In psoriatic arthritis interdisciplinary cooperation of rheumatologist and dermatologist is mandatory.

Schlüsselwörter

Psoriasis - topische Therapie - Systemtherapie - Biologics

Keywords

Psoriasis - systemic treatment - topical treatment - biologics

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