Moderne Aknetherapie

Abstract

ZusammenfassungAkne ist die häufigste dermatologische Erkrankung: Rund 70 ± 87 % aller Jugendlichen weisen Akneläsionen auf, 10 ± 30 % davon benötigen eine medikamentöse Therapie. Bei der Mehrzahl der Patienten erfolgt nach der Pubertät eine spontane Rück-bildung, davon 2 ± 7 % mit erheblicher Narbenbildung. In 10 % der Fälle persistiert die Erkrankung über das 25. Lebensjahr hinaus. Die Auswahl eines Behandlungsschemas ist von der exakten Klassifikation der Akne und der Einordnung des Schweregrades abhängig. Insbesondere stellt die Entwicklung von Narben das Hauptkriterium für die Wahl einer systemischen Therapie dar. Retinoide für die nicht-entzündlichen und Benzoylperoxid für die entzündlichen Akneläsionen sind die Medikamente der ersten Wahl für eine topische Aknetherapie, wobei die Azelainsäure für milde Akneformen und zur Erhaltung eines Therapierfolges geeignet ist. Die Anwendung topischer Antibiotika nimmt ± insbesondere aufgrund der Entwicklung resistenter Bakterienstäm-me durch ihren Einsatz ± kontinuierlich ab. Bei der topischen Therapie spielt die Wahl der Grundlage eine übergeordnete Rolle. Antibiotika, Antiandrogene ± in der Form von hormonellen Kontrazeptiva ± und Isotretinoin sind die aktuellen Pfeiler der systemischen Aknetherapie. Kortikosteroide werden bei der Therapie der Acne fulminans, niedrig dosiert auch bei der Behandlung von Patienten mit adrenalem Hypergonadismus eingesetzt. Aktuelle neue Entwicklungen könnten interessante Perspektiven in der zukünftigen Therapie der Akne anbieten. AbstractAcne is the most common skin disease with a prevalence of 70 ± 87% in adolescents. Ten to 30% of the individuals involved require medical treatment. The majority of patients experiences a spontaneous resolution of the disease after puberty, however in 2-7% the lesions heal with significant scarring. Ten percent of the patients exhibit persistence of their lesions over the age of 25 years. The selection of a therapeutic regimen is dependent on the classification type of acne and its severity grade. In particular, the major criterium leading to the decision for a systemic treatment is the development of scars. Retinoids and benzoyl peroxide are first choice topical drugs for the non inflammatory and the inflammatory lesions, respectively. Azelaic acid is only recommended for mild acne lesions and for the preservation of a successful therapeutic result obtained by another regimen. The application of topical antibiotics is continuously reduced, especially due to the development of resistant bacterial strains. The type of the vehicle is essential for the effectiveness of the topical treatment. Antibiotics, antiandrogens (in hormonal contraceptive preparations), and isotretinoin are the milestones of systemic acne treatment. Corticosteroids are administered in acne fulminans, also as low dose regimen in acne patients with adrenal hypergonadism. Currently, new developments offer interesting perspectives for the future acne treatment.

S2k – Guideline on the Therapy of Acne

“…In order to be able to determine suitable therapy regimens for the varying clinical pictures and different ages of manifestation, a good understanding of the pathogenesis of the disease and possibilities for targeted symptomatic or even etiological therapy is indispensable [9,22]. It is traditionally maintained that various factors contribute to the onset of acne, including increased activity of the sebaceous glands with seborrhea, abnormal follicular differentiation and increased cornification, as well as microbial hypercolonization and inflammatory reactions with a persistent immune response [21].…”

In vitro epidermis model mimicking IGF‐1–specific age‐related decline

“…These results confirm that our organotypic epidermis model, built on IGF-1R impairment, demonstrates a good ability to approach important aspects of hormonal ageing on skin. [2] Sex hormones are declined with age and affect cell-cell communication as illustrated by Makrantonaki and colleagues in their study on 17beta-oestradiol and IGF-1 on fibroblasts and sebocytes. [40] Bearing this example in mind, the present model could be accurate to further transpose 2D studies to 3D skin in vitro and explore more complex interactions in a context closer to skin physiology.…”

The wound‐healing response and upregulated embryonic mechanisms: brothers‐in‐arms forever

“…With accelerating age, skin functions deteriorate, and the incidence of chronic non-healing is increased. Multiple pathways are involved in the pathogenesis of aged skin, including alterations in DNA repair and stability, mitochondrial function, cell cycle, apoptosis, extracellular matrix activity and cellular metabolism (103).…”