Treatment Of Chronic Hand Eczema Research Articles

Efficacy and safety of oral alitretinoin as treatment for chronic hand eczema in France: a real-life open-label study.

Chronic hand eczema is an inflammatory dermatosis that results in a significant psychological and socio-economic burden. Alitretinoin (AL) is indicated in adults with severe chronic hand eczema (sCHE) unresponsive to potent topical corticosteroids. To assess AL effectiveness and safety in patients with sCHE under real-life conditions based on a prospective observational study in France (2010-2014). Clinical severity was assessed using Physician Global Assessment (PGA) and Modified Total Lesion Symptom Score (mTLSS) and quality of life by Skindex and visual analogue scales. Patients were treated with AL for 12-24 weeks and followed for 24 months. Responders were patients with clear/almost clear skin based on PGA at the end of treatment and the primary outcome was remission (clear, almost clear, or mild skin) at one and two years after treatment. A total of 394 patients with severe or moderate PGA were included in the study by 109 dermatologists. AL treatment duration was 5.4 ± 4.1 months (mean ± SD) and 112/274 patients evaluated at the end of treatment were responders. Of the 112 responders, 41/51 evaluable patients were in remission after one year and 36/46 after two years. At the end of treatment, Skindex improved from 48.8 ± 18.1% to 27.1 ± 23.2%. Among the 112 responders, 68/84 did not relapse (mTLSS increased >75% from baseline). The most common adverse events were headache (24%) and dyslipidaemia (4%). This study supports a positive benefit/risk profile for AL for sCHE patients unresponsive to topical corticosteroids.

Efficacy and Safety of Alitretinoin Therapy in Korean Elderly Patients with Chronic Hand Eczema: A Retrospective Single Center Study.

BackgroundChronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that alitretinoin is an effective and well-tolerated treatment for CHE. However, there is a relative lack of data on the effectiveness of alitretinoin in elderly patients.ObjectiveThe aim of this study was to investigate the efficacy and safety of oral alitretinoin in elderly patients with moderate to severe CHE in Korea.MethodsWe retrospectively investigated 46 CHE patients who were treated with either 10 mg or 30 mg of alitretinoin between June of 2016 and July of 2018. The physician's global assessment (PGA) was used to evaluate treatment efficacy. All adverse events were retrospectively evaluated with respect to laboratory testing, including complete blood cell count, fasting blood chemistry, lipid profile, and liver and thyroid function tests.ResultsThe mean patient age in this study was 71.0±5.1 years. The treatment period was over eight weeks. A total of 38 of 46 patients (82.6%) exhibited clinical improvement with PGA ratings of ‘clear’ or ‘almost clear.’ There were 13 patients (28.3%) who experienced an adverse effect, with the most common being headache (13.0%) and gastrointestinal symptoms (8.7%) followed by xerosis (6.5%). A total of 13 patients developed or exhibited worsening hypertriglyceridemia (28.3%).ConclusionAlitretinoin can be considered a safe and effective treatment option in elderly patients with moderate to severe CHE.

Efficacy and safety of intralesional triamcinolone acetonide in the treatment of chronic hand eczema

This randomized controlled clinical trial was conducted to assess the efficacy and safety of intralesional triamcinolone acetonide in the treatment of chronic hand eczema comparing with topical clobetasol propionate. A total 60 patients of chronic hand eczema were recruited in the study. Thirty patients (Group A) were treated with intralesional triamcinolone acetonide and the rest 30 (Group B) with topical clobetasol propionate. Severity and improvement were assessed using Hand Eczema Severity Index (HECSI) score. The patients of both groups were followed up at 4th week and 12th week. In Group A, median HECSI score at baseline, 4th week and 12th week were 3, 20 and 20 respectively; whereas these scores were 54, 10 and 8 in Group B. In both groups, HECSI score was decreased gradually but the rate was higher in Group B than Group A (p<0.05). Thinning of skin, an adverse effect, was seen in patients of both the intralesional triamcinolone acetonide (10%) and topical clobetasol propionate (16.7%) groups (p>0.05). The result of this study demonstrates that intralesional triamcinolone acetonide is effective and safe in treating chronic hand eczema but less effective than the topical clobetasol.

Alitretinoin for the treatment of severe chronic hand eczema.

Chronic hand eczema is a common and often debilitating condition. Alitretinoin, a 9-cis-retinoic acid and pan-retinoic acid agonist, is a new and effective systemic treatment for chronic hand eczema, which provides another treatment option. A “clear” or “almost clear” response can be achieved in up to half of patients within a 24-week course of treatment. Even higher rates of remission can be obtained with a longer duration of treatment. Alitretinoin has a favorable overall profile of adverse effects; however, female patients who are at risk of becoming pregnant should follow a strict pregnancy-prevention program due to the teratogenic effects of this drug.

Alitretinoin for the treatment of chronic hand eczema: clinical rationale

Chronic hand eczema (CHE), an inflammatory skin disease, places heavy psychosocial and economic burden on the affected individual and society as a whole. Patch testing is recommended to identify potential causative allergens in each patient. Efficacy of traditional topical treatments render the management of CHE challenging. Oral alitretinoin (9-cis-retinoic acid) is a new drug for the treatment of severe, refractory CHE. This review summarizes the advances on oral alitretinoin for the treatment of severe CHE, with emphasis on its particular benefit for hyperkeratotic hand eczema, and discusses pharmacodynamics and pharmacokinetics, clinical trials and knowledge gaps.

Treatment of Darier disease with oral alitretinoin

Darier disease (DD) is an autosomal dominant skin disease. Treatment is often difficult and unsatisfactory because of the chronic nature of the condition and the irritant potential of various therapeutic agents. Systemic vitamin A derivatives such as acitretin and isotretinoin are the treatment of choice, but their use is often limited by class-specific side-effects. Alitretinoin (9-cis-retinoic acid), has antiproliferative and anti-inflammatory potential, and is licensed for the systemic treatment of chronic hand eczema in a number of countries. Unlike acitretin, alitrenoin requires contraception in women of childbearing age to be extended for only 1 month after the end of treatment. There is evidence that alitretinoin might be a well-tolerated alternative for the systemic treatment of various retinoid-responsive skin diseases. We present two cases of women with refractory DD successfully treated with alitretinoin without marked side-effects, who both obtained near-complete remission of their skin lesions.

Combined oral alitretinoin and narrowband UVB treatment of cutaneous T cell lymphoma: favourable response after multiple ineffective systemic therapies

ejd.2012.1857 Auteur(s) : Stephanie Motschenbacher, Kristina Buder, Matthias Goebeler, Andreas Kerstan kerstan_a@klinik.uni-wuerzburg.de Department of Dermatology, Venereology, and Allergology, University Hospital of Wurzburg, D-97080 Wurzburg, Germany Oral alitretinoin (9-cis-retinoic acid) is a unique panagonist retinoid with immunomodulatory and anti-inflammatory activity that has emerged as a novel treatment for chronic hand eczema [1]. Due to its binding capability to both retinoic acid (RAR) [...]

Is there still a role for psoralen ultraviolet A in the treatment of chronic hand eczema?

Is there still a role for psoralen ultraviolet A in the treatment of chronic hand eczema?

Is there still a role for psoralen ultraviolet A in the treatment of chronic hand eczema?

Is there still a role for psoralen ultraviolet A in the treatment of chronic hand eczema?

Response to Treatment With Oral Alitretinoin in Patients With Chronic Hand Eczema That Is Refractory to Treatment With Potent Topical Corticosteroids: Experience in 15 Patients

Background Alitretinoin (9- cis-retinoic acid) is an endogenous derivative of vitamin A and functions as an agonist of both families of nuclear receptors (retinoic acid receptor-α, -β, -γ; retinoid X receptor-α, -β, -γ). It has been investigated in the treatment of chronic hand eczema in many studies in recent years and the results have been promising. Objectives To evaluate the efficacy and safety of oral alitretinoin in the treatment of chronic hand eczema that is refractory to treatment with potent topical corticosteroids and to analyze the long-term response to treatment. Materials and methods A prospective, observational, descriptive study was undertaken in 15 patients with chronic hand eczema that was refractory to treatment with potent topical corticosteroids. Patients were administered oral alitretinoin 30 mg/d for 3 months followed by 6 months of follow-up. Results A complete response, with “clear” hands was obtained in 7 patients (47%), 5 patients (33%) achieved a partial response (almost clear hands), 1 patient (7%) showed substantial improvement, 1 (7%) showed moderate improvement, and 1 patient (7%) did not respond to treatment. Relapse occurred within 6 months of treatment suspension in 54% of cases. The treatment was well tolerated. Side effects, observed in 50% of cases, were mild (headache, elevated lipid levels, slightly elevated transaminase levels, and epigastric pain), except in 1 patient, who had a substantial reduction in thyroid stimulating hormone levels. Conclusions The results of our study support the proposal of alitretinoin as an effective and safe short-term and medium-term treatment for chronic hand eczema in patients whose disease is refractory to treatment with potent topical corticosteroids.

CARPE: a registry project of the German Dermatological Society (DDG) for the characterization and care of chronic hand eczema

The aim of the CARPE (German acronym: Chronisches Handekzem-Register zum Patienten-Langzeitmanagement; meaning: chronic hand eczema registry on long-term patient management) registry is to investigate characteristics and treatment modalities in patients affected by chronic hand eczema in Germany. The registry was built up under the auspices of the German Dermatological Society (Deutsche Dermatologische Gesellschaft, DDG). Patients with chronic hand eczema are prospectively assessed by dermatological examination and patient questionnaire. Socio-economic data and data on diagnostics, skin status, severity and treatment of chronic hand eczema and atopy criteria are repeatedly assessed. Here, we present baseline characteristics of the first 515 patients. 53.8 % of the patients were female, mean age was 47.3 years. The average duration of CHE was 7.7 years. 30.4 % had already received inpatient care, 31.2 % had been on sick leave in the past 12 months. 94.5 % had received topical corticosteroids prior to inclusion in the registry, 31.9 % topical calcineurin inhibitors, 38.3 % UV therapy, 28.6 % systemic antihistamines, 36.5 % systemic treatments, 14.9 % systemic corticosteroids, 25.8 % systemic retinoids. The CARPE project demonstrates the high medical burden and therapeutic challenge of chronic hand eczema and presents first data for health care research. Furthermore, the designed follow-up study will present important data about the natural history and prognosis of this chronic skin disease.

Respuesta al tratamiento con alitretinoína oral en ECM refractario con eczema crónico de manos refractario al tratamiento con corticoides tópicos potentes: nuestra experiencia en 15 pacientes

Background Alitretinoin (9- cis-retinoic acid) is an endogenous derivative of vitamin A and functions as an agonist of both families of nuclear receptors (retinoic acid receptor-α, -β, -γ; retinoid X receptor-α, -β, -γ). It has been investigated in the treatment of chronic hand eczema in many studies in recent years and the results have been promising. Objectives To evaluate the efficacy and safety of oral alitretinoin in the treatment of chronic hand eczema that is refractory to treatment with potent topical corticosteroids and to analyze the long-term response to treatment. Materials and methods A prospective, observational, descriptive study was undertaken in 15 patients with chronic hand eczema that was refractory to treatment with potent topical corticosteroids. Patients were administered oral alitretinoin 30 mg/d for 3 months followed by 6 months of follow-up. Results A complete response, with “clear” hands was obtained in 7 patients (47%), 5 patients (33%) achieved a partial response (almost clear hands), 1 patient (7%) showed substantial improvement, 1 (7%) showed moderate improvement, and 1 patient (7%) did not respond to treatment. Relapse occurred within 6 months of treatment suspension in 54% of cases. The treatment was well tolerated. Side effects, observed in 50% of cases, were mild (headache, elevated lipid levels, slightly elevated transaminase levels, and epigastric pain), except in 1 patient, who had a substantial reduction in thyroid stimulating hormone levels. Conclusions The results of our study support the proposal of alitretinoin as an effective and safe short-term and medium-term treatment for chronic hand eczema in patients whose disease is refractory to treatment with potent topical corticosteroids.

Versorgungsforschung am Beispiel des Handekzems

Hand eczema is one of the most frequent skin diseases with a lifetime prevalence of up to 15% and a median incidence rate of 6 cases per 1000 person-years. Female gender, contact allergy, atopic eczema and wet work have been identified as the most important associated risk factors. Hand eczema has a high public health and socio-economic significance, since the vast majority of occupational skin disease is hand eczema. Hand eczema is often chronic, chronically relapsing or persisting. It entails substantial impairment of health-related quality of life for the affected individual. The cost-of-illness of hand eczema is estimated to be in the range of moderate to severe psoriasis and even higher than that of atopic eczema. Although various therapeutic options to treat hand eczema exist, an assessment of these options in randomized, controlled clinical trials to build up an evidence base is mostly lacking. The investigation of the treatment of chronic hand eczema under everyday conditions in dermatological clinics and private practices has only just begun. The first register of patients with chronic hand eczema (acronym: carpe) is expected to yield substantial insights in the effectiveness and safety of different therapeutic measures. A related task is the assessment of the quality of care in the light of the guidelines for the management of chronic hand eczema.

Changes in skin barrier during treatment with systemic alitretinoin: focus on skin susceptibility and stratum corneum ceramides

Alitretinoin is a new drug for systemic treatment of chronic hand eczema. Previous functional tests of skin topically treated with retinoids have indicated impaired skin barrier function, but no data are available on barrier parameters after systemic alitretinoin treatment. To investigate the effect of systemic alitretinoin on skin barrier function and response to irritants, a secondary objective was to determine if changes occur in the lipid profile of stratum corneum after treatment with systemic alitretinoin. We conducted an open clinical intervention study on eight people ascribed to systemic alitretinoin treatment. The criteria for being ascribed to alitretinoin were chronic hand eczema and insufficient therapeutic response to potent topical corticosteroids. Before initiation and after 2 months of systemic treatment with 30 mg alitretinoin, a challenge with sodium lauryl sulphate (SLS) was performed on the volar forearm and evaluated by trans-epidermal water loss (TEWL), erythema, and a cyanoacrylate skin sample was obtained for lipid analysis. We found no significant changes in response to SLS irritation as evaluated by TEWL and erythema, after treatment with alitretinoin for 2 months. No significant changes in stratum corneum lipids were found after 2 months of treatment. In conclusion, systemic alitretinoin does not influence skin susceptibility to irritants or the ceramide profile of stratum corneum.

Update on the use of alitretinoin in treating chronic hand eczema

Chronic hand eczema is a debilitating dermatological condition with significant economic, social, and functional impacts. To date, conventional treatments such as topical corticosteroids, phototherapy, and systemic immunosuppressants have yielded disappointing results, owing to either a lack of efficacy or significant adverse events. Oral alitretinoin (9-cis-retinoic acid) is a unique panagonist retinoid with immunomodulatory and anti-inflammatory activity that has emerged as a novel treatment for chronic hand eczema. Several large-scale clinical studies have demonstrated oral alitretinoin's high efficacy rate of 28% to 89%, its safe tolerability profile, and its positive impact on quality of life, validating it as a therapeutic option for patients with severe chronic hand eczema refractory to standard treatment.

Treatment of atopic eczema with oral alitretinoin

Conflicts of interest: M.G. and A.W. have received financial support and S.M., J.C.P. and T.R. have conducted clinical trials with alitretinoin and have received financial support from Basilea Pharmaceuticals GmbH, the manufacturer of oral alitretinoin. However, there was no financial support for the clinical observation submitted here. Madam, Chronic hand eczema (CHE) is a distressing disease of the palms with variable aetiology, severity and morphology. Clinical phenotypes essentially distinguish hyperkeratotic and dyshidrotic or mixed disease patterns. The underlying disease mechanisms include allergic contact dermatitis, irritative damage and atopy.1 Alitretinoin (9‐cis retinoic acid) is a novel antagonist vitamin A derivative, which binds both retinoic acid receptors (RAR) and retinoid X receptors (RXR). It has recently been licensed for oral treatment of CHE in several European countries.2 The clinical efficacy of alitretinoin for CHE has been confirmed in two large, randomized, double‐blinded, placebo‐controlled, clinical trials.3, 4 We wondered if oral alitretinoin would also be effective in extrapalmar atopic eczema (AE) lesions of patients with atopic CHE, or if side‐effects would limit its potential use in AE.

Measurement of patient‐relevant benefits in the treatment of chronic hand eczema – a novel approach

The assessment of patient-relevant treatment benefit gains importance in treatment evaluation. The 'Patient Benefit Index' (PBI) is a validated instrument for the assessment of such benefits in patients with skin diseases. Patients rate the importance of specific treatment needs before treatment and benefits achieved after treatment. To date, no specific instrument for chronic hand eczema (CHE) has been published. Development and validation of a specific PBI for treatment evaluation in patients with CHE. Items reflecting disease burden and treatment needs were collected in 20 patients with CHE. Relevant items were selected by an expert panel of dermatologists, psychologists, and patients. The resulting 'Patient Benefit Index for chronic hand eczema' (PBI-HE) was validated in an open label treatment study with alitretinoin in n = 249 patients. Cronbach's alpha was 0.93. High convergent validity was demonstrated for clinical improvement and treatment success (Spearman r = 0.60-0.78, P < 0.001); 84.3% of patients reached a PBI >or= 1, indicating more than minimum patient-relevant benefit of alitretinoin. Feasibility was high, with a rate of missing data < 1%. The PBI-HE is a feasible, reliable, and valid instrument for the assessment of patient-relevant treatment benefits in CHE.

Management von Handekzemen Leitlinie ICD-10-Ziffer: L20. L23. L24. L25. L30.

© Dt. Dermatologische Gesellschaft u. a. • Journal compilation © Blackwell Verlag GmbH, Berlin • JDDG • 1610-0379/2009/Suppl 3 – S1–S15 JDDG | Supplement 3 2009 (Volume 7) 1 Preamble Hand eczema (HE), also known as hand dermatitis [note 1], is one of the most common diseases of the skin. Eczema of the hands is not a homogenous disease entity, but instead occurs in various forms, and comprehensive differential diagnosis is often necessary. The disease can range in severity from very mild to chronic severe disease that can even prevent the patient from working for extend ed periods of time and may be refractory to treatment. Chronic hand eczema is very costly and involves significant impairment of the quality of life of the patient. Several therapy options are avail able, but the treatment of chronic hand eczema is often difficult and unsatisfactory. Therapy is complex and requires multimodal management. Large, highquality, randomized controlled clinical studies on the effectiveness of even estab lished therapy options are lacking. The following guideline provides a starting point for an evidence-based approach to hand eczema, presenting the classification, diagnosis, prevention, therapy, and rehabilitation of this disease. Other relevant guidelines are also mentioned for further reference. 2 Objectives The diagnosis and treatment of hand eczema is difficult. Dermatologists in particular face a challenge, as affected patients usually seek the advice of a dermatologist who is then charged with performing appropriate testing and overseeing treatment. The goal of this guideline, which is primarily aimed at dermatologists, is to outline the classification, diagnosis, therapy, and advising of patients with hand eczema and to make recommendations for a standard ized approach to the disease (Figure 1). Guideline on the Management of Hand Eczema

Alitretinoin &amp;ndash; its use in intractable hand eczema and other potential indications

Chronic hand eczema is a significant cause of morbidity. A number of treatments are traditionally used, and often useful, but in spite of this a sizeable group of patients develop chronic recalcitrant hand eczema. Retinoids are known to influence keratinization and inflammation, and acitretin has shown some effect in the treatment of chronic hand eczema. Alitretinoin (9-cis-retinoic acid) is a panagonist retinoid binding to all six known retinoid receptors (RAR-alpha, -beta, -gamma and RXR-alpha, -beta, -gamma). Several studies have been carried out with this new drug, and it has been shown to be effective in 28% to 89% of patients with previously intractable hand eczema. In addition, alitretinoin appears to have some potential in the treatment of AIDS-related Kaposi sarcoma. Attempts to use the drug in secondary prophylaxis has shown some promise in former tobacco smokers, whereas no effect was seen in patients with cervical intraepithelial neoplasia. Currently, the primary therapeutic potential of alitretinoin appears to be the treatment of chronic recalcitrant hand eczema, which also forms a large and hitherto neglected group of patients.

Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema: incorrect assertion of treatment equivalence (response to Saleem Mustafa Taibjee)

Local narrowband UVB phototherapy vs. local PUVA in the treatment of chronic hand eczema: incorrect assertion of treatment equivalence (response to Saleem Mustafa Taibjee)