Behandlung des atopischen Ekzems mit topischen Calcineurininhibitoren

Abstract

During the last years the enormous progress in the understanding of the complex pathomechanisms underlying immune-mediated and inflammatory skin diseases has allowed for the development of novel therapeutic strategies. Among several drugs and biologics being investigated for dermatological use currently calcineurin inhibitors such as tacrolimus and pimecrolimus appear to be the most promising. Recently topical preparations of both tacrolimus (Protopic) and pimecrolimus (Elidel) have been developed and are available for the treatment of atopic dermatitis. Since the introduction of topical corticosteroids more than 50 years ago these novel compounds are the first major development in the topical treatment of inflammatory skin diseases. Both drugs exert a potent antiinflammatory activity and the immunosuppressive potential of pimecrolimus in particular is minimal. Both compounds are well tolerated, do not cause skin atrophy and are safe during long-term application. Application site adverse events mainly consist of a transient sensation of burning which more frequently has been observed after the use of Protopic. The risk of systemic exposure after topical application is low and usually transient. In most of the cases blood levels were below the limit of quantification and in particular Pimecrolimus blood levels never reached a range of potential toxicity. In many short- and long-term studies Protopic-ointment as well as Elidel-cream has been shown to be highly effective. The symptoms of atopic dermatitis such as pruritus and eczema were found to improve within a few days. According to first reports both Protopic and Elidel also appear to be highly effective in the treatment of other inflammatory skin diseases. Future studies will reveal whether early and perhaps prophylactic application of topical calcineurin-inhibitors may prevent flare progression and improve long-term disease control.