Chronic hand eczema and hepatogenic pruritus with good response to apremilast

Abstract

Hand eczema (HE) presents a high prevalence and severe impact on the quality of life of the patients. HE is a worldwide problem recognized for his high socio‐occupational involvement. Treatment is mainly based on adequate recommendations for hand care together with topical anti‐inflammatory treatments. Frequently, patients require systemic treatments such alitretinoin, among others. The comorbidities of the patients and the side effects of the treatments sometimes require prescribing other treatments off label on the technical data. This role in immunomodulation has led to the development of new studies that investigate what role does apremilast have in eczematous diseases, such as atopic dermatitis. We present this case for the quick and complete response of HE with apremilast, and the effective control of hepatogenic pruritus. These finding open a new possibility and alternative treatment of this complex and difficult of control with the treatments already described in the literature.

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

“…[99][100][101]103,147,150 However, it has safety concerns, particularly for women of childbearing age who must adhere to strict birth control measures. 100,104,151 Gusacitinib and dupilumab are emerging as possible effective treatment options for CHE, 34,35,46,49,53,125,132,138 but are still in early phases of study and are financially costly for patients. 143,144 The significant disease burden of chronic and moderateto-severe cases, in combination with the frequent lack of response of such cases to topical therapeutics, advocates for a new treatment paradigm.…”

“…78,[116][117][118][119][120] Apremilast, a small molecule systemic drug that has showed a good safety profile in the treatment of psoriasis, [121][122][123] has also been seen in clinical case series to successfully treat CHE, showing 90% clearance and a reduction in pruritus. 124,125 Methotrexate and systemic corticosteroids have also been empirically used for the treatment of moderate-tosevere chronic hand eczema. 82,[126][127][128][129] Although smaller scale studies, case reports, and retrospective reviews have found modest efficacy in their use, neither has been formally investigated in a registered clinical trial for the treatment of CHE.…”

Synergistic Effects of the 308-nm Excimer Light and Topical Calcipotriol for the Treatment of Chronic Hand Eczema: A Randomized Controlled Study

“…Topical medications including emollients, topical corticosteroids, topical calcineurin inhibitors [6] and topical calcipotriol [7, 8] were reported with good to excellent outcomes for CHE. However, in more severe cases, phototherapy such as psoralen + ultraviolet A and ultraviolet B (UVB) [9] and systemic drugs like alitretinoin [10], cyclosporine [11], methotrexate [12] and apremilast [13] could also exhibit their good outcomes.…”

Apremilast as an Off-Label Therapeutic Agent

“…[41][42][43] Studies have also investigated management of other eczematous, pruritic conditions (chronic pruritus, prurigo nodularis, hand eczema, allergic contact dermatitis) with apremilast and found trends towards improvement in itch and quality of life. [44][45][46] Participants with prurigo nodularis saw a 15% improvement in visual analog scale (VAS) for itch and a 21% improvement in the DLQI as well as a trend in decreasing interleukin 10 (IL-10) and IL-31 expression over 12 weeks, however the changes were not statistically significant. 44 Separately, 66% of participants with chronic pruritus saw resolution of their itch over 16 weeks with material improvement in DLQI.…”