Alitretinoin for the treatment of severe chronic hand eczema

Abstract

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.

Current and emerging therapies for hand eczema

“…Of note, several studies have shown that alitretinoin is most efficacious in patients with hyperkeratotic HE King et al, 2014;. In the aforementioned study of 1,032 patients with CHE, 49% of those with hyperkeratotic CHE achieved PGA of "clear/almost clear,"…”

“…Acitretin is a second-generation retinoid that binds selectively for RAR-α, -β, -γ (King et al, 2014;Petersen & Jemec, 2009;Politiek, Christoffers, et al, 2016). As with alitretinoin, acitretin also demonstrates notable efficacy in patients with hyperkeratotic CHE.…”

“…However, there is no consensus on the specific duration required to classify HE as CHE. CHE affects up to 9% of adults and has a 1-year prevalence of 10% (Coenraads, 2012;King, McKenna, & Alexandroff, 2014;Veien, Hattel, & Laurberg, 2008b). Maarouf, Tran, Hendricks, and Shi (2018) reported that patients with atopic dermatitis (AD) had the greatest pain burden in the hands and toes, which are anatomic regions associated with greater cutaneous sensory nerve density.…”

Alitretinoin in dermatology-An update

“…[ 52 ] Vitamin A and other retinoids should not be taken along with alitretinoin because of the risk of hypervitaminosis A. [ 53 ] Systemic alitretinoin may increase the hepatotoxicity of methotrexate when given together and so must be avoided.…”

“…Other side effects include myalgia, facial flushing, dyspnea, hypertriglyceridemia, hypercalcemia and a decrease in the levels of thyroid-stimulating hormone. [ 53 ] Topical alitretinoin is associated with erythema and edema at application sites and rarely complications like vesiculation, burning, exfoliation and pareasthesias may develop. [ 7 ] Alitretinoin like other retinoids is also a teratogenic drug.…”