Alitretinoin: A Review in Severe Chronic Hand Eczema

Hannah A. Blair, Lesley J. Scott

Chronic hand eczema is a common but frequently disabling skin condition which poses a significant social and economic burden. Although skin protection measures and topical therapies are fundamental in its management, some patients are refractory to first-line therapy with topical corticosteroids and require systemic treatment. Alitretinoin (9-cis-retinoic acid; Toctino(®)) is an endogenous vitamin A derivative with high binding affinity for both retinoic acid receptors and retinoid X receptors. Alitretinoin is the first systemic treatment to be approved in the EU for use in patients with severe chronic hand eczema unresponsive to potent topical corticosteroids. This article updates an earlier review of alitretinoin in this indication, focusing on recently published data. In clinical trials, treatment with alitretinoin 10 or 30 mg once daily for up to 24 weeks improved the severity and extent of severe chronic hand eczema in adults, with significantly more alitretinoin than placebo recipients achieving ratings of 'clear' or 'almost clear' hands on the Physician Global Impression of Change scale. For the most part, data obtained in real-world studies were consistent with those observed in clinical trials. Alitretinoin was generally well tolerated, with most adverse events being reversible, dose-dependent and of mild or moderate severity. Thus, oral alitretinoin is a useful treatment option for patients with severe chronic hand eczema unresponsive to potent topical corticosteroids.