Alitretinoin given at well-tolerated doses induced clearing of CHE in a substantial proportion of patients with severe disease refractory to standard therapy.

Cyclosporin (CyA) has been shown to be highly effective and well tolerated in the short-term treatment of severe childhood atopic dermatitis; however, there is limited experience in its longer-term use. The aim of this study was to compare multiple short courses of CyA with continuous therapy for 1 year, with respect to efficacy, safety, tolerability and quality of life. Children aged 2-16 years, with a diagnosis of severe atopic dermatitis refractory to topical steroid therapy, were randomly assigned to receive short course therapy (multiple courses of 12 weeks) or continuous therapy. The starting dose and maximum dose for all patients was 5 mg/kg per day. Disease activity was monitored using the Six Area Six Sign Atopic Dermatitis score and the 'Rule of Nines' area score. Pruritus, sleep disturbance and irritability were measured using visual analogue scales, and topical therapy was monitored. Safety measurements included monitoring of serum creatinine, blood pressure and adverse events. Forty patients were included in the efficacy analysis, 21 of whom were randomized to the short course group (of whom six were withdrawn) and 19 to the continuous group (of whom five were withdrawn). Significant improvements were seen in all efficacy parameters at every time-point. There were no significant differences between groups, although the improvement was more consistent in the continuous arm. In the short course arm, 7 out of 21 patients could be managed by at least two short courses. The remaining 14 patients includes 12 who could not be controlled by at least two short courses, one patient who failed to return after week 12 and another patient who was withdrawn at week 4 due to an adverse event. Quality of life improved for both the children and their families. Tolerability was considered good or very good in at least 80% of the patients at week 12 and at the end of the study. No clinically significant change was seen in mean serum creatinine and no change was seen in mean blood pressure in either group. CyA is effective in controlling severe atopic dermatitis in children over a 1-year period and is well tolerated. More consistent control is achieved with continuous treatment; however, short course therapy was adequate for some patients, indicating that treatment should be tailored to the individual patient's needs. Short course treatment may produce prolonged remission in some cases and reduce the cumulative exposure to the drug.

Hand eczema (HE) is one of the most frequent skin diseases and has often a chronically relapsing course with a poor prognosis resulting in a high social and economic impact for the individual and the society. In this article, we highlight the results of an expert workshop on the 'management of severe chronic hand eczema' with the focus on the epidemiology, the burden of severe HE, its classification and diagnostic procedures, and the current status of treatment options according to an evidencebased approach (randomized controlled clinical trials, RCTs). We conclude that despite the abundance of topical and systemic treatment options, disease management in patients with severe chronic HE is frequently inadequate. There is a strong need for RCTs of existing and new treatment options based on clearly diagnosed subtypes of HE and its severity. Without doubt, hand eczema (HE) is a very common dermatological condition that often has a high impact on the affected individual and the society. HE is not a uniform disease and varies because of aetiology, severity, and morphology. Although different treatment options exist, the management of patients with chronic HE is often unsatisfactory. In this article, we briefly review the epidemiology, the burden of chronic HE, its classification and diagnostic procedures, and the current status of treatment options. Epidemiology of HEEczema is the most frequent dermatosis affecting the hands. Clinically, HE is characterized by signs of erythema, vesicles, papules, scaling, fissures, hyperkeratosis, and symptoms of itch and pain. If also mild cases are included, the 1-year prevalence of HE is estimated to be up to 10% in the general population (1, 2). About 50% of all patients with hand dermatitis seek dermatological treatment, and about 5% of those are on sick leave from work (3). The proportion of chronic severe HE is estimated to be 5-7% in all patients with HE and those who are refractory to topical treatment are estimated to represent 2-4%. If inability to work is taken as a parameter of severity, 15% of HE cases result in an exclusion from the labour market (4). In most studies, the prevalence among women is higher than among men. Recent results indicate that the high frequency of HE in women in comparison with men is caused by environmental and not genetic factors (5). The increased risk for women to develop HE seems to be present in the age group 20-29 years only, while no increased risk for women is present beyond the age of 30 years (6). Based on a retrospective questionnaire study, the annual incidence of HE is estimated at 5 per 1000 (6). The incidence of notified (i.e. usually more severe) occupation-related cases is estimated to be above 0.7 people per 1000 per year (7). However, the prevalence of work-related HE is underreported and might be 30-50 times higher (8). Among certain occupational groups engaged in wet work or exposed to irritant and/or allergic substances such as hairdressers, cooks, health care workers, metal industry workers, cleaners etc., the 1-year pre...

After atopic dermatitis had been stabilised the addition of fluticasone propionate twice weekly to maintenance treatment with emollients significantly reduced the risk of relapse.

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