Zusammenfassung Wir berichten ?ber eine Patientin mit langj?hrig bekannter Psoriasis vulgaris, die nach ca. f?nf-monatiger Ustekinumab-Therapie erstmals eine atopische Dermatitis entwickelte, welche in unmittelbarem Zusammenhang mit der Applikation des neuen Medikaments (Hautver?nderungen jeweils ca. 2???3 Wochen nach Subkutangabe) aufgetreten war. Zuvor war keine Erkrankung aus dem atopischen Formenkreis bekannt. M?glicherweise bewirkt Ustekinumab ?ber die Hemmung der TH1-Immunantwort einen Switch zu einer ?berwiegend TH2-vermittelten Immunreaktivit?t, die bei okkulter atopischer Diathese eine atopische Dermatitis auszul?sen vermag. ?hnliche Ph?nomene sind bei TNF-alpha-Blockade beschrieben, allerdings bisher kaum ?ber den IL-12- und IL-23-Signaltransduktionsweg, der durch Ustekinimab gehemmt wird.

The recognition of associated autoimmune disorders is as important as is the assessment of changes in the quality of life. New insight into the pathogenesis may have therapeutic consequences. The relationship between vitiligo and skin cancer and between vitiligo and immunotherapies in patients with metastatic melanoma warrants close clinical monitoring of affected patients and further scientific studies.

The range of treatment options for vitiligo has significantly expanded in the last 10 years and we can offer our patients more effective treatment strategies supported by European guidelines and consensus findings. Topical and UV therapy are-often in combination-the main components of vitiligo treatment. The main outcome parameters include extent and maintenance of gained repigmentation, cessation of spreading, avoidance of side effects and the influence of the treatment on the quality of life. The efficacy of the currently available treatments is often limited. New options include antioxidative or melanocyte-stimulating adjuvant therapies in combination with UV or laser light as well as a topical maintenance treatment to reduce the risk of recurrences. In many cases, psychological support is indicated.

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