Successful Treatment of Recalcitrant Prurigo with Alitretinoin

Abstract

<b><i>Background:</i></b> Chronic itch with secondary scratch lesions such as prurigo has a major impact on quality of life. Due to its relapsing nature and often unknown origin, its treatment is challenging. <b><i>Objective:</i></b> We sought to demonstrate that alitretinoin can be an efficacious and well-tolerated treatment in a patient suffering from chronic itch with concomitant prurigo and psoriatic lesions. <b><i>Methods:</i></b> Case report. <b><i>Results:</i></b> After 1 month of alitretinoin treatment (30 mg daily), itch as well as prurigo and psoriasis lesions decreased markedly. Three cycles of alitretinoin were administered, as each cessation of treatment led to relapse of the symptoms after 6-8 weeks. Tapering of the alitretinoin dose (30 mg every second day) after the third cycle allowed to maintain the effects for over 18 months. <b><i>Conclusion:</i></b> Treatment of refractory prurigo with alitretinoin might be an efficacious alternative to standard therapies. In case of relapse, retreatment with alitretinoin reinduces a further long-lasting response.

Alitretinoin treatment of lichen amyloidosis

“…However, retinoids can aggravate atopic dermatitis because they cause skin dryness. Conversely, it is known that alitretinoin has lower frequencies of mucocutaneous sideeffects and has therapeutic effect in extrapalmar manifestations of AD, as well as various other cutaneous diseases such as chronic hand eczema, pityriasis rubra pilaris, palmoplantar pustular psoriasis, lichen simplex chronicus, lichen planus, and prurigo, and disseminated superficial actinic porokeratosis (Bissonnette, Diepgen, et al, 2010;Bissonnette, Worm, et al, 2010;Bubna, 2015;D'Erme et al, 2014;Gadaldi et al, 2015;Grahovac et al, 2010;Park et al, in press). Therefore, considering the patient's underlying atopic dermatitis, we decided to treat the patient with alitretinoin.…”

“…Although the precise links between patterns of receptor binding and therapeutic effects has not been revealed, the anti-inflammatory and pro-differentiating effects without significant suppression of sebum secretion of alitretinoin, are thought to play a role in the disease process associated with LA, as well as underlying inflammatory cutaneous disease (Tietze et al, 2016). Furthermore, because alitretinoin seems to increase the production of IL-4 that exert inhibitory effect on growth of mast, and consequently decrease pruritogenic IL-31, it may show antipruritic effect (Gadaldi et al, 2015). The present case suggests that oral alitretinoin is an effective and safe therapeutic option for the management of treatment-resistant LA, especially in patients with atopic dermatitis or xerosis cutis.…”

“…In addition, retinoids can regulate levels of several heat-shock proteins and apolipoprotein E, which are thought to be important factors in the formation of amyloid from keratin (Hansen et al, 2001). Conversely, it is known that alitretinoin has lower frequencies of mucocutaneous sideeffects and has therapeutic effect in extrapalmar manifestations of AD, as well as various other cutaneous diseases such as chronic hand eczema, pityriasis rubra pilaris, palmoplantar pustular psoriasis, lichen simplex chronicus, lichen planus, and prurigo, and disseminated superficial actinic porokeratosis (Bissonnette, Diepgen, et al, 2010;Bissonnette, Worm, et al, 2010;Bubna, 2015;D'Erme et al, 2014;Gadaldi et al, 2015;Grahovac et al, 2010;Park et al, in press). Conversely, it is known that alitretinoin has lower frequencies of mucocutaneous sideeffects and has therapeutic effect in extrapalmar manifestations of AD, as well as various other cutaneous diseases such as chronic hand eczema, pityriasis rubra pilaris, palmoplantar pustular psoriasis, lichen simplex chronicus, lichen planus, and prurigo, and disseminated superficial actinic porokeratosis (Bissonnette, Diepgen, et al, 2010;Bissonnette, Worm, et al, 2010;Bubna, 2015;D'Erme et al, 2014;Gadaldi et al, 2015;Grahovac et al, 2010;Park et al, in press).…”

“…Alitretinoin, which is approved for the treatment of chronic hand eczema, is a viable treatment option for various inflammatory cutaneous diseases such as pityriasis rubra pilaris, palmoplantar pustular psoriasis, lichen simplex chronicus, lichen planus, and, prurigo (Bissonnette, Diepgen, et al, 2010;Bissonnette, Worm, et al, 2010;Bubna, 2015;D'Erme et al, 2014;Gadaldi, Erdemo glu, & Yawalkar, 2015;Grahovac, Molin, Prinz, Ruzicka, & Wollenberg, 2010;Park, Oh, Kim, Ko, & Ro, in press). Alitretinoin, which is approved for the treatment of chronic hand eczema, is a viable treatment option for various inflammatory cutaneous diseases such as pityriasis rubra pilaris, palmoplantar pustular psoriasis, lichen simplex chronicus, lichen planus, and, prurigo (Bissonnette, Diepgen, et al, 2010;Bissonnette, Worm, et al, 2010;Bubna, 2015;D'Erme et al, 2014;Gadaldi, Erdemo glu, & Yawalkar, 2015;Grahovac, Molin, Prinz, Ruzicka, & Wollenberg, 2010;Park, Oh, Kim, Ko, & Ro, in press).…”

“…Several therapeutic strategies including topical steroids, oral antihistamines, cyclosporine, and retinoids have been reported as treatment options for patients with LA, but no standardized treatment has been established. Alitretinoin, which is approved for the treatment of chronic hand eczema, is a viable treatment option for various inflammatory cutaneous diseases such as pityriasis rubra pilaris, palmoplantar pustular psoriasis, lichen simplex chronicus, lichen planus, and, prurigo (Bissonnette, Diepgen, et al, 2010;Bissonnette, Worm, et al, 2010;Bubna, 2015;D'Erme et al, 2014;Gadaldi, Erdemo glu, & Yawalkar, 2015;Grahovac, Molin, Prinz, Ruzicka, & Wollenberg, 2010;Park, Oh, Kim, Ko, & Ro, in press). Herein, we describe a case of LA in a patient who previously did not respond to conventional medications for atopic dermatitis, but was improved after treatment with oral alitretinoin.…”