Alte Substanzen, neue Erkenntnisse: Immunmodulatoren und Immunsuppressiva beim kutanen Lupus erythematodes

Zusammenfassung

Für die Therapieentscheidung des kutanen Lupus erythematodes (LE) ist die möglichst genaue Einordnung des Krankheitsbildes in das Spektrum der verschiedenen kutanen Varianten erforderlich. Am häufigsten sind der chronisch-diskoide LE (CDLE) und der subakut-kutane LE (SCLE). Neben der kutanen Ausdehnung ist das Vorhandensein einer extrakutanen Beteiligung für die Therapieentscheidung wichtig. Standardtherapeutika des kutanen LE sind Antimalariamittel (Chloroquin, Hydroxychloroquin) allein oder in Kombination mit systemischen Kortikosteroiden. Auch Arthralgien/Arthritiden werden durch diese Therapie günstig beeinflusst. Bei anderen, extrakutanen Manifestationen wird dem Azathioprin der Vorzug gegeben. In 80 - 90 % der Patienten erzielt man mit der Standardtherapie ein gutes therapeutisches Ansprechen. Alternativ hierzu können, bei Therapieversagern oder wenn die Standardtherapie aus anderen Gründen nicht einsetzbar ist, orale Retinoide, Thalidomid, Methotrexat oder Diaminodiphenylsulfon versucht werden. In neueren, kasuistischen Mitteilungen wird über die erfolgreiche lokale Anwendung von Tacrolimus und den systemischen Einsatz von Mycophenolatmofetil beim kutanen LE berichtet.

Abstract

For therapy of cutaneous lupus erythematosus the precise classification of the clinical subset is necessary. The most frequently found LE subsets are chronic discoid LE (CDLE) and subacute cutaneous LE (SCLE). Extension of the cutaneous lesions and presence of visceral involvement are criteria for therapy choice. Basic therapeutics for cutaneous LE are antimalarials (chloroquine, hydroxychloroquine) alone or in combination with systemic corticosteroids. For visceral involvement others than arthralgia/arthritis azathioprin is the first line therapy. In 80 - 90 % of the patients disease can be controlled by these standard therapies. In the remaining cases oral retinoids, thalidomide, methotrexate or diaminodiphenylsulfon can be tried. Recently, a few case reports have been published on a good therapeutic effect of local tacrolimus and systemic mycophenolate mofetil in cutaneous LE.

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