CD14 The use of alitretinoin for chronic hand eczema

Published Date: 19th July 2016

Publication Authors: Walsh ML

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Alitretinoin is specifically licensed for adults with severe chronic hand eczema that has not responded to potent topical steroids. Severe disease is defined by the Physician's Global Assessment (PGA) and a Dermatology Life Quality Index (DLQI) of > 15. Our aim was to assess compliance to NICE guidance (National Institute for Health and Care Excellence. Alitretinoin for the Treatment of Severe Chronic Hand Eczema. TA177. London: National Institute for Health and Care Excellence, 2009) and to determine the efficacy and outcome of alitretinoin in treating hand eczema in Merseyside and North Wales. We conducted a retrospective audit looking at all adults who had been commenced on alitretinoin between November 2012 and December 2013. Data were collected from seven different trusts in Merseyside and North Wales. Sixty-five patients had been started on alitretinoin in the specified time period. The majority were aged between 50 and 70 years, with a median age of 54 years. Overall 62% (n = 40) were female, 11% (n = 7) were manual workers and 38% (n = 25) had experienced eczema for more than 10 years. The largest category, at 22% (n = 14), were of the mixed eczema type, followed closely by the hyperkeratotic group (17%, n = 11). Forty-two patients (65%) had not been on previous systemic therapy. Twenty-seven patients (42%) fulfilled the NICE eligibility criteria to start alitretinoin, having documented PGA of severe and DLQI > 15. The majority of patients 78% (n = 51) were started on 30 mg once daily, and most (58%, n = 38) were on treatment for 12-24 weeks. Thirty-three patients (51%) experienced side-effects, mainly headaches and hyperlipidaemia. In total 77% of patients (n = 50) responded to treatment (complete response 28%, n = 18; partial response 49%, n = 32). Twenty-three patients (35%) relapsed upon stopping treatment, of whom 17 (74%) did so within 3 months. Twelve patients went onto have a repeat course, with 92% (n = 11) of these responding to treatment (complete response n = 4, partial n = 7). In conclusion, alitretinoin does appear to be efficacious for a variety of eczema types, with the majority of patients responding to treatment. Early relapses following treatment were noted, but most of those receiving a second course of alitretinoin did respond to treatment.

Meah, N; Peers, V; Walsh, M. (2014).  CD14 The use of alitretinoin for chronic hand eczema: Results of a regional audit . British Journal of Dermatology. 171 (Supplement S1), 136-37

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