Expression of retinoid receptors in hand eczema

Abstract

Background Hand eczema is the most common occupational skin disease. The etiology is multifactorial. Systemic alitretinoin, a pan-retinoic receptor agonist, has proven efficacy in the treatment of recalcitrant chronic hand eczema; however, its precise mechanism of action in hand eczema is not fully understood.Aims Assessment of the level of expression of retinoid receptors (RAR and RXR) in the skin of patients with hand eczema in an attempt to explain their possible role in the pathogenesis of the disease.Methods Thirty patients with hand eczema and 30 age-and sex-matched healthy controls were included. Full clinical examination was done, and tissue levels of retinoic acid receptor (RAR) and retinoid x receptor (RXR) were measured by quantitative real-time PCR (qRT-PCR). ResultsThe levels of RAR and RXR expression were significantly downregulated in the patient group compared to the control group; (P < 0.001) for both. In addition, there was a statistically significant negative correlation between Osnabr€ uck Hand Eczema Severity Index (OHSI) and the levels of RAR and RXR expression (P < 0.001).Conclusion Deficient retinoid receptor expression has a primary role in the pathogenesis, clinical phenotype, and severity of hand eczema and sheds light on the mechanism of action of retinoids in the treatment of chronic hand eczema.

Drugs for the Treatment of Chronic Hand Eczema: Successes and Key Challenges

“…Systemics may require less frequent and precise patient compliance, 94 but they are often associated with a higher side effect profile, which can be a deterrent for patients. One systemic therapeutic, alitretinoin, a retinoid vitamin A derivative, is approved for moderate-to-severe CHE in Europe, Canada, Israel, and South Korea, [95][96][97][98] showing efficacy in treating refractory CHE in several large studies, as below. Retinoids are systemic vitamin A derivatives that treat CHE by targeting the retinoic acid receptors A and/or X, which have been found to be downregulated in CHE skin.…”

“…Retinoids are systemic vitamin A derivatives that treat CHE by targeting the retinoic acid receptors A and/or X, which have been found to be downregulated in CHE skin. 98,99 Targeting these receptors decreases inflammation by inhibiting keratinocyte-derived vascular endothelial growth factor, inhibiting keratin gene expression, and decreasing levels of IgE, Th2, and Th17 cells, while also increasing levels of Treg cells. 1,[100][101][102] Several studies have shown alitretinoin to be efficacious in the treatment of CHE.…”

Handekzem – Gleiche Therapie für alle Formen?

“…Selten treten Kopfschmerzen auf. Unter Dosisreduktion von den üblichen 30 mg auf 10 mg kann die Therapie meist ohne Kopfschmerzen fortgesetzt werden [32,33,34]. Auch beim Handekzem bei Kindern zeigt sich ein sehr gutes Ansprechen.…”