Safe and effective use of alitretinoin in children with recalcitrant hand eczema and other dermatoses – a retrospective analysis

Abstract

Background Alitretinoin is a systemic retinoid licensed for use in adult patients suffering from chronic hand eczema recalcitrant to potent topical steroids. Experience with its use in childhood is lacking.Objectives To report on the efficacy and safety of alitretinoin treatment in a cohort of children and adolescents with chronic hand eczema (CHE) and other inflammatory skin diseases. MethodsWe performed a retrospective chart review of all consecutive patients under the age of 18 years treated with alitretinoin at our paediatric skin centre. Physician's Global Assessment (PGA) was used as the primary outcome measure.Results Thirteen children (9 girls and 4 boys) were enrolled in this study. The median age at start of treatment with alitretinoin was 11.5 years (range 5.8-15.8 years). Nine children were diagnosed with CHE, two with severe atopic dermatitis (AD), and two with inherited ichthyosis [netherton syndrome (NS), autosomal recessive congenital ichthyosis (ARCI)].Moderate to excellent response (PGA decrease of ≥1 point) was observed in 7 (78%) of the nine patients with CHE, one of the two patients with extensive AD and in the one patient with ARCI. In the remaining four subjects, no convincing effect was documented. Tolerability was overall very good. The most common adverse event was headache in 10 patients (77%) during the initiation of treatment, leading to interruption of therapy in one subject.Conclusions Alitretinoin seems to be highly effective and safe for the treatment of paediatric CHE and should thus be considered in children with refractory disease under topical therapy. Larger studies are required to corroborate these findings.

Outcomes of Systemic Treatment in Children and Adults With Netherton Syndrome: A Systematic Review

“…The youngest patients were a few months old, the oldest patient was 43 years of age. In two patients, age was not reported ( 50 , 67 ). 25 patients were male and 20 patients were female.…”

“…In 18 patients simultaneous use of topical treatments including corticosteroids was reported during treatment with the systemic agents (see Table 1 ). 7 patients received multiple systemic treatments for NS simultaneously which sometimes prevented interpretation of treatment results ( 38 , 56 , 65 , 67 , 70 ).…”

Pediatric chronic hand eczema: Epidemiology, clinical presentation, and management

“…6 Another study of 9 children with P-CHE found an average Hand Eczema Severity Index score correlating to severe disease before initiation of alitretinoin therapy; however, there was selection bias because all children failed multiple therapies before starting alitretinoin. 25,26 These 6 studies constitute the bulk of the literature on the signs, symptoms, disease course, and outcomes in pediatrics. Hand eczema studies in adults show that the disease process presents with edema, erythema, or vesiculation in its acute form, and fissuring, scaling, or crusting chronically.…”

Handekzem – Gleiche Therapie für alle Formen?

“…Auch beim Handekzem bei Kindern zeigt sich ein sehr gutes Ansprechen. Allerdings entwickelten Dreiviertel der Kinder in dieser kleinen Pilotstudie (N = 13) Kopfschmerzen [35]. Das Acitretin, das seine Wirkung nur über den RA-Rezeptor entfaltet, ist im Vergleich zum Alitretinoin und Ciclosporin in die dritte Reihe gerückt.…”