Download PDF
Kinder- und Jugendmedizin 2004; 04(03): 98-106
DOI: 10.1055/s-0037-1617820
Dermatologie
Schattauer GmbH

Autoimmunerkrankungen der Haut im Kindesalter

Autoimmune disorders of the skin in childhood
Michael Sticherling
1   Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig (Direktor der Klinik: Prof. Dr. med. Jan C. Simon)
› Author Affiliations
Further Information

Publication History

Publication Date:
12 January 2018 (online)

    Permissions and Reprints

Zusammenfassung

Autoimmunerkrankungen der Haut sind im Kindesalter eher selten, jedoch von großer differenzialdiagnostischer Bedeutung. Wie im Erwachsenenalter ist die Ätiopathogenese dieser sehr heterogenen Krankheitsgruppe nicht geklärt, wenn auch infektiöse Ursachen besonders häufig verdächtigt werden. Das klinische Bild kann gegenüber dem Erwachsener variieren, während das diagnostische Vorgehen ähnlich ist. Primär systemische Vaskulitiden sind im Kindesalter sehr selten, insbesondere im Vergleich zu infekt-hyperergischen vaskulitischen Krankheitsbildern. Manifestationen der Kollagenosen an der Haut sind sehr vielfältig und nicht obligat vorhanden. Autoimmunbullöse Erkrankungen betreffen ausschließlich das Hautorgan, sind jedoch nicht minder beeinträchtigend. Die Therapie dieser verschiedenen Erkrankungen stellt im Kindes- und Adoleszentenalter eine große Herausforderung an die Patienten, Eltern wie auch betreuende Ärzte. Die häufig chronischen Erkrankungen erfordern krankheits- und aktivitätsabhängig eine immunsuppressive oder immunmodulatorische Therapie, deren kurz- und langfristige Nebenwirkungen die körperliche und psychische Entwicklung der Kinder erheblich beeinflussen können.

Summary

Autoimmune diseases of the skin are rare in childhood, however of considerable importance for differential diagnosis. Similar to adult diseases, their etiopathogenesis remains to be elucidated in detail. Infectious causes are, however, often suspected. Whereas the clinical picture may vary compared to adult manifestations, the diagnostic procedures are similar. Primary systemic vasculitides are very rare in childhood in contrast to hyperergic-post infectious vasculitides. Skin manifestations of collagenoses are diverse and not always present. In contrast autoimmune bullous skin diseases singly target the skin organ, are however of similar impact for afflicted patients. Therapeutic procedures for these very heterogenous disorders are demanding for patients, their parents as well as caring medical personal. Depending on disease manifestation and activity as well as the often chronic course, immunosuppressive or immunomodulatory treatment has to be initiated. This may dramatically influence both the the somatic and psychologic development of the young patients.

Schlüsselwörter

Autoimmunerkrankungen - Kollagenosen - Vaskulitiden - blasenbildende Erkrankungen

Keywords

Autoimmune disorders - collagenoses - vasculitis - bullous diseases
 

  • Literatur

  • 1 Arkachaisri T, Lehman TJ. Use of biologics in the treatment of childhood rheumatic diseases. Curr Rheumatol Rep 2000; 2: 330-6.
    CrossrefPubMedGoogle Scholar
  • 2 Athreya BH. Vasculitis in children. Pediatr Clin North Am 1995; 42: 1239-61.
    CrossrefPubMedGoogle Scholar
  • 3 Athreya BH. Juvenile scleroderma. Curr Opin Rheumatol 2002; 14: 553-61.
    CrossrefPubMedGoogle Scholar
  • 4 Black CM. Scleroderma and fasciitis in children. Curr Opin Rheumatol 1995; 7: 442-8.
    CrossrefPubMedGoogle Scholar
  • 5 Bottoni CR, Reinker KA, Gardner RD, Person DA. Scleroderma in childhood: a 35-year history of cases and review of the literature. J Pediatr Orthop 2000; 20: 442-9.
    PubMedGoogle Scholar
  • 6 Burch JM, Lee LA, Weston WL. Neonatal lupus erythematosus. Dermatol Nurs 2002; 14: 157-60.
    PubMedGoogle Scholar
  • 7 Callot-Mellot C, Bodemer C, Caux F, Bourgault-Villada I, Fraitag S, Goudie G, Heller M, de Prost Y, Prost C. Epidermolysis bullosa acquisita in childhood. Arch Dermatol 1997; 133: 1122-6.
    CrossrefPubMedGoogle Scholar
  • 8 Collison CH, Sinal SH, Jorizzo JL, Walker FO, Monu JU, Snyder J. Juvenile dermatomyositis and polymyositis: a follow-up study of long-term sequelae. South Med J 1998; 91: 17-22.
    CrossrefPubMedGoogle Scholar
  • 9 Dalakas MC, Illa I, Dambrosia JM, Soueidan SA, Stein DP, Otero C, Dinsmore ST, Mc Crosky S. A controlled trial of high-dose intravenous immune globulin infusions as treatment for dermatomyositis. N Engl J Med 1993; 329: 1993-2000.
    CrossrefPubMedGoogle Scholar
  • 10 Dantzig P. Juvenile dermatomyositis treated with cyclosporine. J Am Acad Dermatol 1990; 22: 310-1.
    CrossrefPubMedGoogle Scholar
  • 11 DeSilva TN, Kress DW. Management of collagen vascular diseases in childhood. Dermatol Clin 1998; 16: 579-92.
    PubMedGoogle Scholar
  • 12 Dieterich W, Ehnis T, Bauer M, Donner P, Volta U, Riecken EO, Schuppan D. Identification of tissue transglutaminase as the autoantigen of celiac disease. Nat Med 1997; 3: 797-801.
    CrossrefPubMedGoogle Scholar
  • 13 Duffy CM, Laxer RM, Lee P, Ramsay C, Fritzler M, Silverman ED. Raynaud syndrome in childhood. J Pediatr 1989; 114: 73-8.
    CrossrefPubMedGoogle Scholar
  • 14 Edwards S, Wakelin SH, Wojnarowska F, Marsden RA, Kirtschig G, Bhogal B, Black MM. Bullous pemphigoid and epidermolysis bullosa acquisita: presentation, prognosis, and immunopathology in 11 children. Pediatr Dermatol 1998; 15: 184-90.
    CrossrefPubMedGoogle Scholar
  • 15 Eisenstein DM, Paller AS, Pachman LM. Juvenile dermatomyositis presenting with rash alone. Pediatrics 1997; 100: 391-2.
    CrossrefPubMedGoogle Scholar
  • 16 Farrington ML, Haas JE, Nazar-Stewart V, Mellins ED. Eosinophilic fasciitis in children frequently progresses to scleroderma-like cutaneous fibrosis. J Rheumatol 1993; 20: 128-32.
    Google Scholar
  • 17 Foeldvari I. Scleroderma in children. Curr Opin Rheumatol 2002; 14: 699-703.
    CrossrefPubMedGoogle Scholar
  • 18 Goebeler M, Zillikens D. Blasenbildende Hauterkrankungen der Kindheit. Hautarzt 2003; 54: 14-24.
    CrossrefPubMedGoogle Scholar
  • 19 Geyer AS, Zillikens D, Skrobek C, Cohen B, Anhalt GJ, Nousari HC. Vesicular pemphigoid in a 16-year-old boy. J Am Acad Dermatol 2003; 49: 722-4.
    CrossrefPubMedGoogle Scholar
  • 20 Jablonska S. The therapies for linear IgA bullous dermatosis of childhood. Pediatr Dermatol 1999; 16: 415.
    PubMedGoogle Scholar
  • 21 Jennette JC, Falk RJ. Overview of the nomenclature and diagnostic categorization of vasculitis. Wien Klin Wochenschr 20.
    Google Scholar
  • 22 Jorizzo JL. Dermatomyositis: practical aspects. Arch Dermatol 2002; 138: 114-6.
    PubMedGoogle Scholar
  • 23 Lee LA, Weston WL. Cutaneous lupus erythematosus during the neonatal and childhood periods. Lupus 1997; 6: 132-8.
    CrossrefPubMedGoogle Scholar
  • 24 Lehman TJ. Systemic and localized scleroderma in children. Curr Opin Rheumatol 1996; 8: 576-9.
    CrossrefPubMedGoogle Scholar
  • 25 Lehman TJ. Aggressive therapy for childhood rheumatic diseases. When are immunosuppressives appropriate? Arthritis Rheum 1993; 36: 71-4.
    PubMedGoogle Scholar
  • 26 Neiman AR, Lee LA, Weston WL, Buyon JP. Cutaneous manifestations of neonatal lupus without heart block: characteristics of mothers and children enrolled in a national registry. J Pediatr 2000; 137: 674-80.
    CrossrefPubMedGoogle Scholar
  • 27 Paller AS. Juvenile dermatomyositis and overlap syndromes. Adv Dermatol 1995; 10: 309-26.
    PubMedGoogle Scholar
  • 28 Pistoia V, Buoncompagni A, Scribanis R, Fasce L, Alpigiani G, Cordone G, Ferrarini M, Borrone C, Cottafava F. Cyclosporin A in the treatment of juvenile chronic arthritis and childhood polymyositis-dermatomyositis. Results of a preliminary study. Clin Exp Rheumatol 1993; 11: 203-8.
    PubMedGoogle Scholar
  • 29 Prendiville JS, Esterly NB. Childhood dermatitis herpetiformis. Clin Dermatol 1991; 9: 375-81.
    CrossrefPubMedGoogle Scholar
  • 30 Rose C, Dieterich W, Brocker EB, Schuppan D, Zillikens D. Circulating autoantibodies to tissue transglutaminase differentiate patients with dermatitis herpetiformis from those with linear IgA disease. J Am Acad Dermatol 1999; 41: 957-61.
    CrossrefPubMedGoogle Scholar
  • 31 Rottem M, Fauci AS, Hallahan CW, Kerr GS, Lebovics R, Leavitt RY, Hoffman GS. Wegener granulomatosis in children and adolescents: clinical presentation and outcome. J Pediatr 1993; 122: 26-31.
    CrossrefPubMedGoogle Scholar
  • 32 Schaller JG. Diagnosis and management of rheumatic diseases in adolescence. Adolesc Med 1998; 9: 1-10.
    PubMedGoogle Scholar
  • 33 Schmid MH, Trueb RM. Juvenile amyopathic dermatomyositis. Br J Dermatol 1997; 136: 431-3.
    CrossrefPubMedGoogle Scholar
  • 34 Sontheimer RD, Thomas JR, Gilliam JN. Subacute cutaneous lupus erythematosus: a cutaneous marker for a distinct lupus erythematosus subset. Arch Dermatol 1979; 115: 1409-15.
    CrossrefPubMedGoogle Scholar
  • 35 Vancheeswaran R, Black CM, David J, Hasson N, Harper J, Atherton D, Trivedi P, Woo P. Childhood-onset scleroderma: is it different from adult-onset disease. Arthritis Rheum 1996; 39: 1041-9.
    CrossrefPubMedGoogle Scholar
  • 36 Weston WL, Morelli JG, Lee LA. The clinical spectrum of anti-Ro-positive cutaneous neonatal lupus erythematosus. Am Acad Dermatol 1999; 40: 675-81.
    CrossrefPubMedGoogle Scholar
  • 37 Weston WL, Morelli JG, Huff JC. Misdiagnosis, treatments, and outcomes in the immunobullous diseases in children. Pediatr Dermatol 1997; 14: 264-72.
    CrossrefPubMedGoogle Scholar
  • 38 Wever S, Burger M, Langfritz K, Hashimoto T, Nishikawa T, Brocker EB, Zillikens D. Herpes gestationis. Klinisches Spektrum und diagnostische Möglichkeiten. Hautarzt 1995; 46: 158-64.
    PubMedGoogle Scholar