Dermatologische Externa im Kindesalter

Zusammenfassung

Die kindliche Haut bietet verglichen mit Erwachsenen weniger morphologische als vor allem funktionelle Besonderheiten, die für die topische Applikation von Wirksubstanzen von praktischer Bedeutung sind. Um die Zusammenhänge bewerten zu können, sind Grundkenntnisse von der physikochemischen Organisation des Stratum corneums als Grenzkompartiment zwischen Präparation und vitaler Epidermis von essenzieller Bedeutung. Zudem bedarf es eines Grundverständnisses von galenischen Abläufen und Interaktionen, um Behandlungssituationen hinsichtlich einer individuellen Nutzen-Risiko-Bewertung beurteilen zu können. Insgesamt wird deutlich, dass praktisch relevante Risiken insbesondere bei pathologisch veränderter Haut mit Defekten der physikalischen Barriere- und Reservoir-funktion, bei Wärmeeinwirkung und unter Okklusion beachtet werden müssen. Diese liegen vor allem in einer erhöhten systemischen Bioverfügbarkeit mit toxikologischer Relevanz und in irritativen Effekten insbesondere durch Emulgatorwirkungen. Besonders bedeutsam ist im klinischen Alltag der Umgang mit arzneilichen Präparationen, die nicht für die Anwendung im Kindesalter zugelassen sind (Off-label-use). Hierbei gelten besondere juristische Rahmenbedingungen, die eine besondere Sorgfalt in der Therapiewahl voraussetzen.

Summary

The skin of children has compared to adults some particular characteristics which relate more functionality than morphology that need to be considered when applying active substances. Basic knowledge about the physicochemical set-up of the Stratum corneum as a boundary layer between the vital epidermis and a preparation is needed in order to understand the interactions. Also, some insight into galenic features and procedures will be necessary for an individual risk-benefit assessment of treatment. Attention should be paid to relevant risks associated with heat exposure, occlusion or pathologically altered skin involving malfunction or failure of the physical barrier or reservoir function. The most significant risks here are an increased systemic bioavailability with toxicological relevance as well as irritant effects caused by emulsifying agents. A critical point in daily clinical practice is the use of medicinal preparations that have not been approved for treatment in children (off label use). Specific legal framework conditions require extra care and diligence in choosing a therapy.

Schlüsselwörter

Externa im Kindesalter - topische Therapie

Keywords

Topical preparations in childhood - topical therapy

¹ meinem akademischen Lehrer, Herrn Prof. Dr. med. habil. Wolfgang Christian Marsch, zum 64. Geburtstag gewidmet

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