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Alopecia areata

Klinik, Pathogenese und rationale Therapie einer T-Zell-vermittelten Autoimmunerkrankung

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Zusammenfassung

Die Alopecia areata ist eine T-Zell-vermittelte Autoimmunerkrankung, die sich gegen ein bisher unbekanntes Antigen des Haarfollikels richtet. Es besteht eine genetische Prädisposition für die Erkrankung; auslösende Umweltfaktoren ließen sich bisher nicht nachweisen. Das typische klinische Bild des kreisrunden Haarausfalls einschließlich seiner Maximalformen, der Alopecia areata totalis und universalis, ermöglicht in den meisten Fällen die Diagnose, die durch das Vorliegen von Nagelveränderungen untermauert werden kann. Selten wird eine Histologie erforderlich; alle anderen Laboruntersuchungen sind überflüssig. Wegen der hohen Spontanremissionsrate muss die Wirksamkeit einer rationalen Therapie der Alopecia areata in kontrollierten Studien nachgewiesen werden und im Rahmen der Nutzen-Risiko-Abwägung ein geringes Nebenwirkungsprofil aufweisen. Nach den Regeln der evidenzbasierten Medizin ist die Behandlung mit einem Kontaktallergen derzeit die effektivste und nebenwirkungsärmste Therapie der Alopecia areata; da sie aber sehr aufwändig ist und nicht in allen Fällen wirkt, ist die Entwicklung neuer, spezifischerer Therapieformen notwendig.

Abstract

Alopecia areata is a T-cell mediated autoimmune disease directed against an unknown auto antigen of the hair follicle. There is a genetic predisposition to develop alopecia areata, whereas environmental triggers have so far not been identified. The diagnosis can be established by characteristic clinical features of alopecia areata including its severe forms alopecia areata totalis and universalis. Nail changes may help confirm the diagnosis. On rare occasions a histopathological examination may be necessary, whereas other laboratory investigations are unnecessary. Because of the high rate of spontaneous remission, the efficacy of a rational treatment of alopecia areata has to be proven in controlled studies and it should be associated with only minor side effects. According to the rules of evidence-based medicine, treatment with a contact sensitizer is at present the most effective treatment of alopecia areata showing only mild side effects. However, it is time-consuming and in some cases ineffective, making it desirable to develop new, more specific forms of treatment.

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Authors and Affiliations

  1. Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg

    P. Freyschmidt-Paul, R. Happle & R. Hoffmann

  2. Klinik für Dermatologie und Allergologie, Philipps-Universität Marburg, Deutschhausstraße 9, 35033 , Marburg

    P. Freyschmidt-Paul

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  1. P. Freyschmidt-Paul
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  2. R. Happle
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  3. R. Hoffmann
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Correspondence to P. Freyschmidt-Paul.

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Freyschmidt-Paul, P., Happle, R. & Hoffmann, R. Alopecia areata. Hautarzt 54, 713–722 (2003). https://doi.org/10.1007/s00105-003-0560-z

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