Psoriasis – eine Volkskrankheit im Umbruch

Zusammenfassung

Die Psoriasis ist mit einer Prävalenz von 2 % eine der häufigsten Hautkrankheiten mit einer großen medizinischen, aber auch einer enormen psychosozialen und gesundheitsökonomischen Bedeutung. Insbesondere für Patienten mit schweren Psoriasis-Formen sowie mit Psoriasisarthritis waren die Therapieoptionen bis Ende des vergangenen Jahrhunderts häufig unbefriedigend. Dies änderte sich schlagartig mit der genaueren Aufklärung der Pathogenese, die zu einer Etablierung der Psoriasis als Modellbeispiel für T_H1-vermittelte chronisch-entzündliche Erkrankungen führte und die eine Einführung von Biologicals in die Psoriasistherapie ermöglichte. Neben den bisher zugelassenen TNF-α-Antagonisten und dem LFA-1-Antikörper Efalizumab befinden sich derzeit vielversprechende neue Biologicals in der Entwicklung und klinischen Prüfung, insbesondere Antikörper gegen die gemeinsame p40-Proteinuntereinheit von Interleukin 12 und 23. Solche IL12/23-p40-Antikörper hemmen nicht nur die Differenzierung zu T_H1-Zellen, sondern auch die Entstehung von T_H17-Zellen, einem neu entdeckten, für die Pathogenese der Psoriasis bedeutsamen Typ von T-Zellen. Das Krankheitsbild Psoriasis erscheint daher heute für Forscher sowie für Kliniker spannender als je zuvor. In den letzten Jahren wurde zudem deutlich, dass Psoriasis-Patienten ein wesentlich erhöhtes Risiko für kardiovaskuläre und metabolische Erkrankungen besitzen. Diese Erkenntnis trug zu einem Paradigmenwechsel bei, nach dem die Psoriasis heute nicht mehr als haut- und gelenkspezifische Krankheit, sondern als Multisystemerkrankung betrachtet wird. Eine neue Aufgabe der Dermatologen ist nunmehr, insbesondere für Risikopatienten geeignete Screening-Untersuchungen zu veranlassen.

Abstract

Psoriasis is, with a prevalence of 2 %, one of the most frequent dermatological diseases with a great medical, but also an enormous psychosocial and health economic impact. Until the end of the last century, therapeutic options were often dissatisfactory, in particular for patients with severe forms of psoriasis and with psoriatic arthritis. This changed abruptly when the pathogenesis was elucidated more precisely, leading to an establishment of psoriasis as a model example of T_H1-mediated chronic inflammatory diseases and allowing the introduction of biologicals into antipsoriatic therapy. In addition to the TNF-α antagonists and the LFA-1 antibody efalizumab approved at present, promising new biologicals are currently being developed and evaluated in clinical trials, especially antibodies against the common p40 protein subunit of interleukin 12 and 23. Such IL12/23-p40 antibodies inhibit the differentiation into T_H1 cells, but also the development of T_H17 cells, a newly discovered type of T cells with great importance for the pathogenesis of psoriasis. Today psoriasis appears as a more exciting disease than ever before, both for researchers and for clinicians.

Moreover, it has become evident during the last years that patients with psoriasis have a substantially increased risk for cardiovascular and metabolic diseases. This contributed to a change of paradigm, after which psoriasis has to be considered no longer as a skin- and joint-specific disease, but as a multisystem disorder. Hence, a new task for dermatologists is to arrange suitable screening examinations, particularly for high risk patients.

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