Clinical Medicine Insights: Dermatology

Chronic hand eczema (CHE) is a very common and distressing dermatological condition which follows a remitting and relapsing course over time. Traditional treatment strategies are limited and unsatisfactory, particularly for patients who are unresponsive to potent topical corticosteroids. Studies have demonstrated that alitretinoin is effective and well tolerated in the treatment of severe CHE. In a large-scale clinical trial, a 30 mg dose of alitretinoin produced ‘clear’ or ‘almost clear’ hands in nearly half of patients treated, with a 75% median reduction in signs and symptoms by 24 weeks, and with 4 out of 5 patients showing an improvement. Furthermore, the small percentage of patients who relapsed 6 months after responding to initial treatment with alitretinoin were successfully re-treated with a second course of the drug. Treatment with alitretinoin is generally well tolerated, with manageable side effects consistent with other retinoid therapies. Alitretinoin is the first and only evidence-based therapy specifically licensed for the treatment of severe CHE unresponsive to topical corticosteroids. Clinical experience of alitretinoin post license indicates similar efficacy and tolerability to the clinical trial environment, supporting its place as a first line treatment option in CHE guidelines published to date.