DECISAProject (DErmatologyClinics in Italy: Survey on Alitretinoin): A real‐life retrospective cohort multicenter study on 438 subjects with chronic hand eczema

Abstract

Alitretinoin is the only systemic agent approved to treat moderate‐severe chronic hand eczema (CHE) unresponsive to potent topical corticosteroids. No nationwide Italian data regarding real‐life efficacy, safety, and tolerability of treatment are available. The DECISA project (DErmatology Clinics in Italy: Survey on Alitretinoin) retrospectively examined data from a registry including 15 Dermatology Clinics authorized to prescription of alitretinoin for CHE patients. Disease severity was assessed at baseline, and after 3 and 6 months of treatment, using the 5‐point Physician Global Assessment (PGA) and the modified Total Lesion‐Symptoms‐Severity (mTLSS) scores. Between November 2010 and July 2018, data of 248 male and 190 female patients (mean age 49.71 ± 13.20 years) treated with alitretinoin were collected. Of them, 43.2% had irritant contact dermatitis, 22.2% allergic contact dermatitis, 18.0% atopic dermatitis, 16.7% mixed (irritant/allergic) type of eczema. At 3 months, the 420 re‐evaluated patients showed significantly reduced mTLSS and PGA (P < .0000001 vs baseline for both); PGA was clear/almost clear in 35.6% of cases. At 6 months, the 341 re‐evaluated patients showed significant (P < .0000001) improvement of mTLSS and PGA vs baseline and 3 months (PGA clear/almost clear: 41.4%). Relapses occurred in 125 patients; 58 underwent an additional course of alitretinoin, with similarly good results. No relevant safety issues were reported; 86 patients experienced adverse effects, which forced 40 to prematurely stop treatment. The DECISA project results confirm the real‐life efficacy, safety and tolerability of alitretinoin in the treatment of moderate to severe CHE refractory to standard topical therapies.

Clinical phenotypes of adult atopic dermatitis and related therapies

“…From the literature data it is very difficult to highlight the efficacy of the drug in atopic dermatitis, as patients with different diagnoses are mainly aggregated [50]. In an Italian multicentre study, 438 patients were treated with alitretinoin, 38.6% with a diagnosis of atopic dermatitis of the hand; a progressive significant improvement was recorded after 3 and 6 months of treatment; 17.6% (n ¼ 77) of patients experienced adverse effects (mainly headache and dyslipidemia), and 7.1% (n ¼ 31) of study population had to stop treatment because of these effects; however, no significant changes in efficacy and frequency of adverse effects were observed between the atopic patients and those with another diagnosis [51].…”

“…Furthermore, several other adverse events have been described, the most frequent being headache, dyslipidemia, thyroid disfunction, and psychiatric disorders [50]. Alitretinoin is widely reported to be effective in chronic hand eczema, including hand atopic dermatitis [50,51]. On the other hand, it appears to be inefficacious for other atopic dermatitis affected body areas or phenotypes [50,51].…”

“…Alitretinoin is widely reported to be effective in chronic hand eczema, including hand atopic dermatitis [50,51]. On the other hand, it appears to be inefficacious for other atopic dermatitis affected body areas or phenotypes [50,51]. From the literature data it is very difficult to highlight the efficacy of the drug in atopic dermatitis, as patients with different diagnoses are mainly aggregated [50].…”

Work-Related Hand Eczema in Healthcare Workers: Etiopathogenic Factors, Clinical Features, and Skin Care

“…However, there have been suggestions of a potential association between topical calcineurin inhibitors and skin cancer and lymphoma, though the evidence is not strong [105,106]. In addition, for systemic treatments, alitretinoin has been found to be effective in treating chronic hand eczema, with 43.2% of patients diagnosed with irritant contact dermatitis showing positive results in one study [107]. In cases where other first-or second-line treatments have failed, oral immunomodulators may be necessary for chronic irritation.…”

Irritant Contact Dermatitis — a Review

“…TCIs have been shown to be favorable in the treatment of ICD [ 121 , 122 ]. Other systemic treatments include alitretinoin, which has been shown to be an effective treatment in study of patients with chronic hand eczema, 43.2% of whom were diagnosed with ICD [ 123 ].…”