Efficacy of alitretinoin depending on the concomitant use of topical corticosteroids in chronic hand eczema patients

Abstract

Alitretinoin is the only systemic agent approved for the treatment of severe chronic hand eczema (CHE) unresponsive to potent topical corticosteroids. Clinical trials have shown the efficacy of oral alitretinoin with topical emollients for CHE treatment, but most studies have failed to reach a therapeutic success rate of 50%. Reasonably, we thought it would be more effective to combine topical corticosteroids with oral alitretinoin, but the concomitant use of topical corticosteroids has not been studied yet. One‐hundred and seven Korean patients diagnosed with CHE were recruited. The participants were divided into two groups depending on the concomitant use of topical corticosteroids. Comparative analysis was performed between the combined therapy (alitretinoin and topical corticosteroids) and monotherapy groups (alitretinoin only) by using physician global assessment (PGA), patient's global assessment (PaGA), modified total lesion symptom score (mTLSS), and recurrence rates. The combined therapy group showed a significantly higher treatment success rate than the alitretinoin monotherapy group for all efficacy parameters (PGA: P < 0.001, PaGA: P < 0.001, mTLSS changes: P < 0.001), but there was no significant difference in recurrence rates between the groups (P = 0.266). Combined use of topical corticosteroids is recommended for CHE patients being treated with oral alitretinoin due to clinically rapid and superior effectiveness.

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

“…Oral alitretinoin, a 9- cis -retinoic acid, is widely used as a treatment of choice for CHE. Recently, Cheon et al [23] have revealed the clinical improvement by 44% reduction of the mTLSS following the administration of alitretinoin for an average 15 weeks. Also, a meta-analysis [10] concluded that 50% of the patients had a good percentage of clearance at a high dose of alitretinoin for 24 weeks.…”

Guidelines for diagnosis, prevention, and treatment of hand eczema

“…The efficacy of systemic treatment with alitretinoin was found to be enhanced with the addition of topical corticosteroids. 157 Allergic contact dermatitis caused by a topical corticosteroid, or its vehicle, is not uncommon and should be considered when HE does not respond to topical treatment. 158 Intermittent dosing may reduce the risk of skin atrophy, but little evidence supports this.…”

2020 Korean Consensus Guidelines for Diagnosis and Treatment of Chronic Hand Eczema

“…It is a retinoid with anti-proliferative, anti-inflammatory, and immunomodulatory but not immunosuppressive effects 43 44 . The time to response was significantly shorter with alitretinoin 30 mg than 10 mg, and when combined with a topical corticosteroid, the result was clinically rapid and superior to alitretinoin monotherapy 9 45 . Since relapses were successfully treated with re-administration of alitretinoin 46 , intermittent use of alitretinoin could be suitable for long-term management of chronic hand eczema.…”