GD - Online T. Luger: Topische Immunmodulatoren in derzeitigen und zukünftigen Indikationen
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Prof. Dr. med. Thomas Luger

Topische Immunmodulatoren in derzeitigen und zukünftigen Indikationen: Was ist erreicht? Was ist noch zu tun?

Klinik und Poliklinik für Hautkrankheiten, Westfälische Wilhelms-Universität, Münster/Westfalen

Since the introduction of topical corticosteroids more than 50 years ago, novel topical calcineurin-inhibitors such as pimecrolimus and tacrolimus have been proven to be effective and safe alternatives for the treatment of patients suffering from atopic eczema. Accordingly, pimecrolimus cream and tacrolimus ointment have been approved for the treatment of atopic eczema in adults and children in Europe, the United States and many other countries around the world. Both compounds are safe and well tolerated. Inspite of their immunommodulting capacity no risks for an increase in bacterial or viral skin infections have been observed. Following topical application only a minimal transient systemic exposure that is far below a therapeutic toxic level has been reported.

In addition to atopic eczema recently several small clinical and single case studies have been performed to investigate the efficacy and safety of pimecrolimus and tacrolimus in the treatment of other inflammatory skin diseases. Both have been found to be effective and well tolerated in the treatment of hand eczema and also turned out to be a highly effective treatment for psoriasis in children, particularly for the face and intertrigineous areas. However, plaque type psoriasis only improved if either pimecrolimus or tacrolimus was applied under occlusion.

Many case reports have demonstrated that pimecrolimus cream or tacrolimus ointment can be successfully used for the treatment of skin diseases such as seborrhoiec eczema, steroid induced rosacea, mucous lesions of lichen planus and genital lichen sclerosus et atrophicus. There is also recent evidence that the application of pimecrolimus or tacrolimus is effective for the treatment of certain cases of vitiligo. Further studies demonstrate the efficacy of both compounds in the treatment of pyoderma gangraenosum, skin lesions of systemic lupus erythematosus or dermatomyositis, bullous autoimmunediseases, chronic actinic dermatitis and polymorphic light eruption.

The observed efficacy of pimecrolimus cream and tacrolimus ointment for the treatment of inflammatory allergic and autoimmune skin diseases needs to be further evaluated in controlled clinical trials.

 

Prof. Dr. med. Thomas Luger



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