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Medikamentöse Therapie der Akne

Drug therapy of acne

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Zusammenfassung

Die Behandlung der Akne richtet sich nach dem klinischen Bild. Man versucht, möglichst viele der pathogenetisch relevanten Mechanismen, d. h. Hyperseborrhoe, Verhornungsstörung, Besiedlung mit P. acnes und die Entzündungsreaktion, zu behandeln. Bei leichter Akne ist damit primär eine topische Therapie sinnvoll. Eine Acne comedonica wird mit topischen Retinoiden, eine Acne papulopustulosa mit einer Kombination von Retinoiden und topischen antibakteriellen Substanzen (Benzoylperoxid, Antibiotika, Azelainsäure) behandelt. Bei mittelschweren Formen bzw. solchen mit größerer Ausdehnung werden orale Antibiotika mit topischen Retinoiden und Benzoylperoxid kombiniert. Acne conglobata und andere schwere Manifestationen werden mit Isotretinoin behandelt. Bei Frauen werden außerdem antiandrogen wirksame orale Kontrazeptiva eingesetzt. Schwere entzündliche Akneformen werden initial kurzfristig mit Glukokortikoiden behandelt. Als Therapeutika der 2. Wahl können orales Zink oder Dapson verwendet werden. Zur Erhaltungstherapie nach erfolgreicher Behandlung sind topische Retinoide geeignet.

Abstract

Acne is treated according to the clinical picture and the pathophysiologically relevant mechanisms, such as seborrhea, follicular hyperkeratosis, P. acnes colonisation,and inflammation. In mild forms of acne, topical therapy is most appropriate. Comedonal acne can be treated with topical retinoids; papulopustular acne with a combination of retinoids and topical antimicrobial substances (benzoyl peroxide, antibiotics, or azelaic acid). Moderate forms or those with extrafacial involvement can be treated with oral antibiotics combined with topical retinoids or benzoyl peroxide. Acne conglobata and other severe manifestations are treated with oral isotretinoin. Women are also treated with oral contraceptives containing anti-androgenic progestins. If inflammation is prominent, initial short term treatment with oral glucocorticoids is helpful. Second-line agents include oral zinc or dapsone. Following successful treatment, topical retinoids are suitable for maintenance therapy.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Beide Autoren sind als Referenten für Firmen, die Aknetherapeutika herstellen, tätig gewesen, u. a. Galderma, Hermal und Stiefel.

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Authors and Affiliations

  1. Zentrum Dermatologie und Venerologie, Klinikum der J.W. Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland

    F.R. Ochsendorf

  2. Klinik und Poliklinik für Dermatologie und Allergologie der Ludwig-Maximilians-Universität München, c/o Dermatologische Gemeinschaftspraxis, Pasinger Bahnhofsplatz1, 81667, München, Deutschland

    K. Degitz

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  1. F.R. Ochsendorf
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  2. K. Degitz
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Correspondence to F.R. Ochsendorf.

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Ochsendorf, F., Degitz, K. Medikamentöse Therapie der Akne. Hautarzt 59, 579–590 (2008). https://doi.org/10.1007/s00105-008-1498-y

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  • DOI: https://doi.org/10.1007/s00105-008-1498-y

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