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Jang JH, Joh HC, Song CH, Kim KY, Jue MS, Ro YS, Ko JY. Comparative Study of Efficacy Between Cyclosporine and Alitretinoin in Patients With Chronic Hand Eczema. Dermatitis 2024; 35:258-265. [PMID: 37870578 DOI: 10.1089/derm.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Background: Systemic remedies such as cyclosporine, methotrexate, and retinoids are off-license treatment options that are considered for severe chronic hand eczema (CHE) that is resistant to first-line treatment. Objectives: The objective of this study was to determine the optimal treatment of CHE patients, including those with atopic Dermatitis®, and to compare the efficacy between cyclosporine and alitretinoin. Methods: This study was retrospective and included CHE patients who visited the Department of Dermatology at Hanyang University Seoul Hospital in Korea between March 2013 and February 2020. Results: A total of 95 CHE patients was included in this study. In the cyclosporine treatment group, there were more patients with severe baseline Investigator Global Assessment (IGA) (P = 0.033) and higher immunoglobulin E (IgE) level (P = 0.019). The mean recurrence duration was 15.9 weeks in the alitretinoin group and 22.9 weeks in the cyclosporine group, the difference between which was not statistically significant. In a subgroup analysis according to treatment drug, only the low IgE group showed a better recurrence profile for alitretinoin treatment compared to cyclosporine treatment (P = 0.039). When comparing the cumulative recurrence rate during the treatment period and subsequent follow-up periods, the cyclosporine group showed a greater incidence of recurrence than the alitretinoin group in all follow-up periods. The results of our study are consistent with the previously reported efficacy of alitretinoin. Despite the rapid response in the cyclosporine group, 12 weeks of CHE treatment with alitretinoin showed superior efficacy compared to cyclosporine treatment. Conclusions: Both alitretinoin and cyclosporine groups showed efficacy in patients with CHE. Cyclosporine is an alternative treatment of CHE that is refractory to alitretinoin or relapses after its use, especially in the presence of atopic Dermatitis®.
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Affiliation(s)
- Jin Hyun Jang
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
| | - Hae Chang Joh
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
| | - Chang Hwa Song
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
| | - Ki Yeon Kim
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
| | - Mihn Sook Jue
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
| | - Young Suck Ro
- Department of Dermatology, Daejeon Eulji Medical Center, Eulji University College of Medicine, Daejeon, Korea
| | - Joo Yeon Ko
- From the Department of Dermatology, College of Medicine, Hanyang University, Seoul, Korea
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Tang G, Chang Y, Wu H, Liang X, Liu Y, Zhuo F. Efficacy and Safety of Fractional CO 2 Laser Combined with Halometasone Cream for Treatment of Moderate-to-Severe Chronic Hand Eczema: A Prospective, Single-Center, Parallel-Group, Open-Label Randomized Trial. Dermatol Ther (Heidelb) 2023:10.1007/s13555-023-00944-w. [PMID: 37354295 PMCID: PMC10366065 DOI: 10.1007/s13555-023-00944-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/19/2023] [Indexed: 06/26/2023] Open
Abstract
INTRODUCTION The purpose of this study was to assess the efficacy and safety of fractional CO2 laser combined with halometasone cream in patients with moderate-to-severe chronic hand eczema (CHE). METHODS A prospective, single-center, parallel-group, open-label randomized trial including 67 patients with moderate-to-severe CHE was carried out. Patients were randomly assigned to group A (n = 33, fractional CO2 laser once every 4 weeks 1-2 times and halometasone cream twice daily for 8 weeks) or group B (n = 34, halometasone cream alone twice daily for 8 weeks). The primary endpoint was the proportion of patients achieving treatment success at week 12 in each group. Secondary endpoints included differences between groups in the change of hand eczema severity index (HECSI), patient global assessment (PaGA), dermatology life quality index (DLQI), and quality of life in hand eczema questionnaire (QOLHEQ) from baseline to week 12. Relapse rate and adverse effects were also recorded. RESULTS A total of 29 patients in each group completed the trial. At week 12, the treatment success rate was 62.1% (18/29) in group A and 27.6% (8/29) in group B (p = 0.009). At week 12, HECSI, PaGA, DLQI, and QOLHEQ all decreased compared with baseline in both groups (p < 0.05). HECSI, DLQI, and QOLHEQ decreased more in group A than group B (p = 0.014, 0.010, and 0.014, respectively), but there was no significant difference in change of PaGA between the two groups (1.0 versus 3.0, p = 0.419). Among patients achieving treatment success, 11.1% (2/18) patients in group A and 50.0% (4/8) patients in group B relapsed at week 24 (p = 0.011). Skin pigmentation was the most common adverse effect. CONCLUSIONS For patients with moderate-to-severe CHE, fractional CO2 laser combined with halometasone cream is more effective than halometasone cream alone, with few adverse effects. TRIAL REGISTRATION NUMBER ChiCTR2100051948.
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Affiliation(s)
- Gongfeng Tang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China
| | - Yuan Chang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China
| | - Haixuan Wu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China
| | - Xuelei Liang
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China
| | - Yi Liu
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China
| | - Fenglin Zhuo
- Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, Beijing, China.
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Bednar ED, Abu-Hilal M. Low Dose Oral Alitretinoin With Narrowband Ultraviolet B Therapy for Chronic Hand Dermatitis. J Cutan Med Surg 2022; 26:256-261. [PMID: 35067082 PMCID: PMC9125134 DOI: 10.1177/12034754211071123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Chronic hand dermatitis (CHD) is difficult to treat and has high individual and societal burdens. Phototherapy and oral alitretinoin are safe monotherapies for CHD, but their combination has not been assessed. Objective To assess the effectiveness and safety of low dose oral alitretinoin combined with phototherapy versus high dose oral alitretinoin for CHD refractory to topical corticosteroids. Methods This retrospective study of adult patients with CHD refractory to topical corticosteroid therapy compared low dose oral alitretinoin (10 mg three times weekly) combined with narrowband ultraviolet B therapy (three times weekly; LDA-UVB) to high dose oral alitretinoin (30 mg daily; HDA) for 16 weeks. Outcomes were improvement in disease severity measured by the Physician’s Global Assessment and quality of life measured with the Dermatology Life Quality Index. Results The mean age of the study population (n = 64) was 41.25 years and 57.8% were male. Both cohorts experienced improvements in disease severity and quality of life after 16 weeks, however, significantly more participants who received LDA-UVB (n = 21/33, 63.6%) achieved “clear” or “almost clear” assessments compared to those who received HDA (n = 12/31, 38.7%; P < .05). Adverse effects were significantly more prevalent in the HDA group (P < .0001) and included headache, elevated cholesterol, and dry lips. Conclusions The combination of low dose oral alitretinoin with narrowband-UVB therapy was more effective and had fewer adverse effects compared to high dose oral alitretinoin for participants with CHD refractory to topical corticosteroid therapy.
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Affiliation(s)
- E. Dimitra Bednar
- Michael G. DeGroote School of Medicine, McMaster University, ON, Canada
| | - Mohannad Abu-Hilal
- Division of Dermatology, Faculty of Health Sciences, McMaster University, ON, Canada
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Kim HJ, Bang CH, Kim HO, Lee DH, Ko JY, Park EJ, Son SW, Ro YS. 2020 Korean Consensus Guidelines for Diagnosis and Treatment of Chronic Hand Eczema. Ann Dermatol 2021; 33:351-360. [PMID: 34341637 PMCID: PMC8273322 DOI: 10.5021/ad.2021.33.4.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/17/2020] [Accepted: 01/11/2021] [Indexed: 11/22/2022] Open
Abstract
Background Hand eczema refers to eczema located on the hands, regardless of its etiology or morphology. Despite its high prevalence and significant impact on patients' quality of life, treatment is frequently challenging because of its heterogeneity, chronic and recurrent course, and lack of well-organized randomized controlled trials of the various treatment options. Objective These consensus guidelines aim to provide evidence-based recommendations on the diagnosis and management of hand eczema to improve patient care by helping physicians make more efficient and transparent decisions. Methods A modified Delphi method, comprising two rounds of email questionnaires with face-to-face meetings in between, was adopted for the consensus process that took place between February and September 2020. Forty experts in the field of skin allergy and contact dermatitis were invited to participate in the expert panel. Results Consensus was reached for the domains of classification, diagnostic evaluation, and treatment; and a therapeutic ladder to manage chronic hand eczema was developed. Conclusion These are the first consensus guidelines for chronic hand eczema in the Asian population, which will help standardize care and assist clinical decision-making in the diagnosis and treatment of chronic hand eczema.
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Affiliation(s)
- Hee Joo Kim
- Department of Dermatology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye One Kim
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Dong Hoon Lee
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University College of Medicine, Seoul, Korea
| | - Sang Wook Son
- Department of Dermatology, Korea University College of Medicine, Seoul, Korea
| | - Young Suk Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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Chung BY, Um JY, Kang SY, Jung MJ, Kim JC, Kwak IS, Park CW, Kim HO. Oral Alitretinoin for Patients with Refractory Prurigo. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E599. [PMID: 33182351 PMCID: PMC7695266 DOI: 10.3390/medicina56110599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022]
Abstract
Background: prurigo is a chronic skin disorder associated with a history of chronic pruritus. The pathogenesis of prurigo is largely unknown and the treatment of prurigo is unsatisfactory and challenging. Conventional systemic treatments may be beneficial; however, their possible side effects and possible transient efficacy is still a problem. We aimed to present the clinical course and effect of treatment with alitretinoin on patients with prurigo nodularis initially treated with conventional treatments like oral antihistamine, cyclosporine, and phototherapy. Methods: all the patients had prurigo nodularis refractory to conventional treatment. Their medical records included demographic features, past medical history, duration of disease, and treatment modalities; and the clinical courses of the patients were reviewed for this retrospective study. We evaluated patient pruritus and skin lesions for the duration. Results: we present reports involving 10 patients with refractory prurigo. All the patients in our cases were treated with oral alitretinoin after previous treatments and reported the improvement of skin lesions and pruritus within 2 weeks to 3 months. Conclusions: we suggest that oral alitretinoin may be an effective and well tolerated treatment option for patients with intractable prurigo. Further clinical studies are warranted to confirm the long-lasting efficacy and safety of alitretinoin for treating patients with prurigo.
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Affiliation(s)
- Bo Young Chung
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Ji Young Um
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Seok Young Kang
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Min Je Jung
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Jin Cheol Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - In-Suk Kwak
- Department of Anesthesiology and Pain Medicine, Burn Center, Hangang Sacred Heart Hospital, Hallym University College of Medicine, 94-200 Yeoungdeungpo-dong, Yeoungdeungpo-gu, Seoul 07247, Korea;
| | - Chun Wook Park
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
| | - Hye One Kim
- Department of Dermatology, Kangnam Sacred Heart Hospital, Hallym University college of Medicine, 1, Singil-ro, Yeoungdeungpo-gu, Seoul 07441, Korea; (B.Y.C.); (J.Y.U.); (S.Y.K.); (M.J.J.); (J.C.K.)
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Jindal R, Pandhi D. Hand Hygiene Practices and Risk and Prevention of Hand Eczema during the COVID-19 Pandemic. Indian Dermatol Online J 2020; 11:540-543. [PMID: 32832439 PMCID: PMC7413445 DOI: 10.4103/idoj.idoj_448_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/10/2020] [Accepted: 06/28/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rashmi Jindal
- Department of Dermatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Deepika Pandhi
- Department of Dermatology and STD, University College of Medical Sciences and GTB Hospital, New Delhi, India
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Sobhan M, Hojati M, Vafaie SY, Ahmadimoghaddam D, Mohammadi Y, Mehrpooya M. The Efficacy of Colloidal Oatmeal Cream 1% as Add-on Therapy in the Management of Chronic Irritant Hand Eczema: A Double-Blind Study. Clin Cosmet Investig Dermatol 2020; 13:241-251. [PMID: 32273745 PMCID: PMC7103792 DOI: 10.2147/ccid.s246021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 02/27/2020] [Indexed: 12/15/2022]
Abstract
Background Irritant contact dermatitis (ICD) is the most frequent cause of hand eczema (HE). There is promising evidence with the use of topical oatmeal compounds in the management of inflammation- and itch-responses associated with diverse dermatologic conditions. This study aimed to evaluate the clinical benefit of colloidal oatmeal cream in the management of chronic irritant HE. Methods From October 2018 to November 2019, 79 patients with diagnosis of chronic irritant HE were allocated into either intervention or control groups by block randomization method. Besides fluocinolone 0.025% ointment for the first 2 weeks of treatment period, patients in the intervention and control groups were asked to use colloidal oatmeal 1% cream or base cream for additional 4 weeks as monotherapy. Changes in the HE severity based on the hand eczema severity index (HESCI) score, pruritus severity based on the visual analogue scale (VAS), and impact of skin disorder on patients quality of life based on the Dermatology Life Quality Index (DLQI) from baseline to weeks 2, 4, and 6 were assessed in the study groups. Results Fifty subjects, 26 in intervention and 24 in control, completed the course of the study. The results indicated, though relatively comparable decrease in mean HESI and VAS scores was observed in both groups by the end of week 2, thereafter until end of the study a non-return of symptoms to baseline conditions was observed in the intervention group, while there was a significant return of symptoms to baseline conditions in the control group (p value<0.001 in both conditions). Further, a noticeable improvement in the DLQI score was seen in the intervention group compared with the control group (p value<0.001). Conclusion Findings demonstrate that colloidal oatmeal, a natural product with proven barrier protection, moisturization, anti-inflammatory, and soothing properties, can have ameliorative effects on eczema severity symptoms in patients with chronic irritant HE.
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Affiliation(s)
- Mohammadreza Sobhan
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahsa Hojati
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed-Yaser Vafaie
- Department of Pharmaceutics, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Davoud Ahmadimoghaddam
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Younes Mohammadi
- Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Mehrpooya
- Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
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Tauber M, Bérard E, Lourari S, Questel E, Redoules D, Paul C, Simon M. Latent class analysis categorizes chronic hand eczema patients according to skin barrier impairment. J Eur Acad Dermatol Venereol 2019; 34:1529-1535. [DOI: 10.1111/jdv.16083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/24/2019] [Indexed: 12/14/2022]
Affiliation(s)
- M. Tauber
- Dermatology and Allergology Department Larrey Hospital Toulouse University Toulouse France
- U1056 UDEAR Purpan Hospital INSERM‐University Paul Sabatier Toulouse France
| | - E. Bérard
- Department of Epidemiology, Health Economics and Public Health UMR1027 INSERM‐ Toulouse University Toulouse University Hospital (CHU) Toulouse France
| | - S. Lourari
- Dermatology and Allergology Department Larrey Hospital Toulouse University Toulouse France
| | - E. Questel
- Pierre Fabre Dermo‐Cosmétique Toulouse France
| | - D. Redoules
- Pierre Fabre Dermo‐Cosmétique Toulouse France
| | - C. Paul
- Dermatology and Allergology Department Larrey Hospital Toulouse University Toulouse France
- U1056 UDEAR Purpan Hospital INSERM‐University Paul Sabatier Toulouse France
| | - M. Simon
- U1056 UDEAR Purpan Hospital INSERM‐University Paul Sabatier Toulouse France
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Tauber M, Lourari S, Bérard E, Questel E, Redoules D, Giordano-Labadie F, Simon M, Carle P. Positive change in hand care habits using therapeutic patient education in chronic hand eczema. Contact Dermatitis 2019; 82:10-17. [PMID: 31461531 DOI: 10.1111/cod.13390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/23/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic hand eczema (CHE) is a major burden for patients. Maintenance treatment involves prevention measures limiting detrimental behaviour and aggravating factors. OBJECTIVE To evaluate the effect of a standardised care program including therapeutic patient education (TPE) on hand care behaviours, clinical severity, quality of life, and work productivity. METHODS A single-centre study was conducted prospectively. Together with the prescription of a topical steroid, patients participated in individual TPE sessions. Evaluations were performed initially and repeated three months after the therapeutic intervention. They included a structured analysis of hand care behaviours, the assessment of the mTLSS (modified Total Lesion Symptom Score), DLQI (Dermatology Life Quality Index), and WPAI (Work Productivity and Activity Impairment). RESULTS Seventy-one patients were included (30 men, 42.3%). Three months after completion of the standardised care program, hand care behaviours such as hand washing and rinsing, hand drying, wearing protective gloves, using moisturizing creams, and following specific treatments and recommendations for CHE improved significantly in the 58 patients who completed the study and were associated with a significant improvement in the mTLSS, DLQI, and WPAI scores. CONCLUSIONS TPE helps patients change their hand care behaviours and adopt skin protection measures, and may improve CHE severity, quality of life, and work productivity.
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Affiliation(s)
- Marie Tauber
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France.,UDEAR, U1056 INSERM, Paul Sabatier Toulouse University, Toulouse, France
| | - Siham Lourari
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM- Toulouse University, Toulouse University Hospital (CHU), Toulouse, France
| | | | | | | | - Michel Simon
- UDEAR, U1056 INSERM, Paul Sabatier Toulouse University, Toulouse, France
| | - Paul Carle
- Dermatology and Allergology Department, Larrey Hospital, Toulouse University, Toulouse, France.,UDEAR, U1056 INSERM, Paul Sabatier Toulouse University, Toulouse, France
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Cheon DU, Kim JE, Ko JY, Ro YS. Efficacy of alitretinoin depending on the concomitant use of topical corticosteroids in chronic hand eczema patients. J Dermatol 2019; 46:998-1005. [PMID: 31535403 DOI: 10.1111/1346-8138.15071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/08/2019] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Dong Uk Cheon
- Department of Dermatology, Hanyang University Hospital, Seoul, South Korea
| | - Jeong Eun Kim
- Department of Dermatology, Hanyang University Hospital, Seoul, South Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University Hospital, Seoul, South Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University Hospital, Seoul, South Korea
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Kim HL, Jung HJ, Park MY, Youn JI, Ahn JY. Clinical Efficacy of Oral Cyclosporine on Intractable Hand Eczema: A Retrospective Review of 16 Cases. Ann Dermatol 2018; 30:475-478. [PMID: 30065592 PMCID: PMC6029976 DOI: 10.5021/ad.2018.30.4.475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/10/2017] [Accepted: 08/11/2017] [Indexed: 12/03/2022] Open
Affiliation(s)
- Hong Lim Kim
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Hye Jung Jung
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Mi Youn Park
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Jai Il Youn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Ji Young Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
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Shin K, Kim TW, Park SM, Lee HJ, Jin H, You HS, Shim WH, Kim GW, Kim HS, Ko HC, Kim BS, Kim MB. Alitretinoin can be a good treatment option for idiopathic recalcitrant trachyonychia in adults: an open-label study. J Eur Acad Dermatol Venereol 2018; 32:1810-1814. [DOI: 10.1111/jdv.15024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022]
Affiliation(s)
- K. Shin
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
| | - T.-W. Kim
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
| | - S.-M. Park
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
| | - H.-J. Lee
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
| | - H. Jin
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
| | - H.-S. You
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
| | - W.-H. Shim
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
| | - G.-W. Kim
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
- Biomedical Research Institute; Pusan National University Hospital; Busan Korea
| | - H.-S. Kim
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
- Biomedical Research Institute; Pusan National University Hospital; Busan Korea
| | - H.-C. Ko
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
| | - B.-S. Kim
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
- Biomedical Research Institute; Pusan National University Hospital; Busan Korea
| | - M.-B. Kim
- Department of Dermatology; School of Medicine; Pusan National University; Busan Korea
- Biomedical Research Institute; Pusan National University Hospital; Busan Korea
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13
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Koh WS, Oh EH, Kim JE, Ro YS. Alitretinoin treatment of lichen amyloidosis. Dermatol Ther 2017; 30. [DOI: 10.1111/dth.12537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/18/2017] [Accepted: 07/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Won Seon Koh
- Department of Dermatology; Hanyang University Hospital; Seoul South Korea
| | - Eui Hyun Oh
- Department of Dermatology; Hanyang University Hospital; Seoul South Korea
| | - Jeong Eun Kim
- Department of Dermatology; Hanyang University Hospital; Seoul South Korea
| | - Young Suck Ro
- Department of Dermatology; Hanyang University Hospital; Seoul South Korea
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14
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Thaçi D, Augustin M, Westermayer B, Kamps A, Hennig M. Effectiveness of alitretinoin in severe chronic hand eczema: PASSION, a real-world observational study. J DERMATOL TREAT 2016; 27:577-583. [DOI: 10.1080/09546634.2016.1227422] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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16
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Kwon HI, Kim JE, Ko JY, Ro YS. Efficacy and Safety of Alitretinoin for Chronic Hand Eczema in Korean Patients. Ann Dermatol 2016; 28:364-70. [PMID: 27274636 PMCID: PMC4884714 DOI: 10.5021/ad.2016.28.3.364] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/04/2016] [Accepted: 02/15/2016] [Indexed: 11/28/2022] Open
Abstract
Background Chronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that a 24-week treatment course of oral alitretinoin is effective and well tolerated for CHE treatment. Objective The aim of this study was to investigate the efficacy and safety of oral alitretinoin in Korean CHE patients. Methods A total of 27 patients with moderate to severe CHE took 30 mg of alitretinoin daily for 12 weeks. The primary efficacy parameter was the physician's global assessment (PGA). The response was defined as a patient being "clear" or "almost clear" of disease. The secondary efficacy parameters were the modified total lesion symptom score (mTLSS) and the patients' global assessment (PaGA). All adverse events and laboratory abnormalities were recorded during the treatment period. Results Alitretinoin led to CHE symptom improvement in 44.4% of patients. The PGA, mTLSS, and PaGA scores correlated well with each other. Reported adverse events were typical retinoid class effects and headache was the most common. Conclusion Taking 30 mg of oral alitretinoin daily for 12 weeks was found to be effective in treating Korean patients with CHE, compared with the 24 week-treatment shown in previous studies.
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Affiliation(s)
- Hyoung Il Kwon
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Joo Yeon Ko
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
| | - Young Suck Ro
- Department of Dermatology, Hanyang University College of Medicine, Seoul, Korea
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17
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Reich K, Graff O, Mehta N. Oral alitretinoin treatment in patients with palmoplantar pustulosis inadequately responding to standard topical treatment: a randomized phase
II
study. Br J Dermatol 2016; 174:1277-81. [DOI: 10.1111/bjd.14401] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 02/02/2023]
Affiliation(s)
- K. Reich
- SCIderm Clinical Research and Dermatologikum Stephansplatz 5 D‐20354 Hamburg Germany
| | - O. Graff
- Stiefel, a GSK company Uxbridge U.K
| | - N. Mehta
- Stiefel, a GSK company Uxbridge U.K
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18
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Shroff A, Malajian D, Czarnowicki T, Rose S, Bernstein DM, Singer GK, Lebwohl MG, Hadi S, Guttman-Yassky E. Use of 308 nm excimer laser for the treatment of chronic hand and foot eczema. Int J Dermatol 2016; 55:e447-53. [PMID: 26917041 DOI: 10.1111/ijd.13205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/03/2015] [Accepted: 09/22/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chronic hand and foot eczema (CHFE), a prevalent debilitating disorder affecting approximately 15% of the population, presents a socioeconomic and psychosocial burden for patients and often follows a chronic course, refractory to conventional therapies. Thus, a large need exists for more effective therapeutics; the excimer laser (308 nm) is effective for some inflammatory skin diseases, but its efficacy has not been evaluated for CHFE. METHODS The study is a retrospective chart review conducted on 30 patients with recalcitrant CHFE (19 with hand involvement, four with foot involvement, and seven with both) treated twice weekly with excimer laser (308 nm) single wavelength ultraviolet (UV)B radiation between January 2013 and December 2014. RESULTS Improvements in clinical scores included a 69% reduction in average physician's global assessment (PGA) scores (from 2.77 at baseline to 0.87 after treatment, P < 0.0001) with a parallel reduction in average modified total lesion/symptom scores of 70% (from 10.2 to 3.1, P < 0.0001). Only mild sunburn-like reactions were observed. CONCLUSION This report evaluates excimer laser for patients with refractory CHFE and shows excellent and sustained efficacy for this treatment. Compared to other UV therapies, excimer laser offers lower cumulative doses of UV radiation by targeting specific areas. This effective treatment should be considered alone or in combination with other established or newer therapies.
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Affiliation(s)
- Anjali Shroff
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dana Malajian
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA.,College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Tali Czarnowicki
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
| | - Sharon Rose
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel M Bernstein
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Giselle K Singer
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhail Hadi
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, USA
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Abstract
Alitretinoin is a pan retinoic acid agonist. It was initially used as 0.1% gel in the management of localized Kaposi's sarcoma. At present, the use of systemic alitretinoin has proved extremely efficacious in the management of recalcitrant chronic hand eczema. Furthermore, there have been other retinoid responsive dermatosis that have demonstrated remission post usage of systemic alitretinoin. With a better toxicity profile, compared to the other systemic retinoids, alitretinoin could be considered a valuable treatment option in the near future for the treatment of these dermatologic disorders.
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Affiliation(s)
- Aditya Kumar Bubna
- Department of Dermatology, Sri Ramachandra University, Chennai, Tamil Nadu, India
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20
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Manage hand dermatitis with preventative measures and a stepwise approach to escalating therapy. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Antonov D, Schliemann S, Elsner P. Hand dermatitis: a review of clinical features, prevention and treatment. Am J Clin Dermatol 2015; 16:257-270. [PMID: 25920436 DOI: 10.1007/s40257-015-0130-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Hand dermatitis is a socially significant health problem. This review provides a discussion on the clinical features and patterns as well as the differential diagnosis of hand dermatitis, because these are essential for proper diagnosis in clinical practice. The morphology, however, is poorly related to the etiology in chronic cases. In all cases of chronic hand dermatitis, a full diagnostic examination should be undertaken and the etiology should be clarified and addressed in the treatment concept, instead of just moving directly from a morphological diagnosis to therapy. Preventive measures should be included in the treatment concept according to etiology. A stepwise approach for escalating therapy is advised, including basic topical therapy, topical corticosteroids, calcineurin inhibitors, as well as phototherapy and systemic therapy with corticosteroids, alitretinoin, cyclosporine, methotrexate, azathioprine, and others.
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22
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Jankowska-Konsur A, Reich A, Szepietowski JC. Systemic antihistamines--a common outside the guidelines therapeutic strategy in hand eczema management. J Eur Acad Dermatol Venereol 2015; 30:67-71. [PMID: 25731585 DOI: 10.1111/jdv.13060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hand eczema (HE) is the most common skin disease affecting hands. Although the current treatment guidelines do not recommend use of systemic antihistamines as routine therapy, they seem to be widely used by physicians handling with this problem. OBJECTIVE The aim of the study was to investigate the attitude to prescribe systemic antihistamines in HE. MATERIAL AND METHODS A 10-item questionnaire was distributed among physicians participating in regional dermatological conferences. 127 valid questionnaires were analysed. RESULTS A total of 127 physicians participated in the survey. 124 (97.6%) responders prescribe antihistamines in HE and 16 (12.6%) subjects declared routine use of oral antihistamines in the HE management. Significantly more dermatologists than other specialists used antihistamines in the treatment of HE accompanying atopic dermatitis (77.8% vs. 54.5%, P < 0.01) and dermatologists significantly more commonly used antihistamines in HE due to their anti-inflammatory properties (40.3% vs. 20.0%, P = 0.02). Regarding the type of eczema, antihistamines were prescribed most frequently in acute allergic HE (n = 92, 72.4%) and in HE accompanying atopic dermatitis (n = 86, 67.7%). CONCLUSIONS Despite the lack of the large, randomized, controlled studies on the effectiveness of the systemic antihistamines in the treatment of HE, this type of therapy seems to be prevalently used among the physicians.
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Affiliation(s)
- A Jankowska-Konsur
- Department of Dermatology, Allergology and Venereology, University of Medicine, Wroclaw, Poland
| | - A Reich
- Department of Dermatology, Allergology and Venereology, University of Medicine, Wroclaw, Poland
| | - J C Szepietowski
- Department of Dermatology, Allergology and Venereology, University of Medicine, Wroclaw, Poland
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23
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Milanesi N, D'Erme AM, Gola M. Nail improvement during alitretinoin treatment: three case reports and review of the literature. Clin Exp Dermatol 2015; 40:533-6. [DOI: 10.1111/ced.12584] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- N. Milanesi
- Allergological and Occupational Dermatology Unit; Department of Surgery and Translational Medicine; University of Florence; Firenze Italy
| | - A. M. D'Erme
- Allergological and Occupational Dermatology Unit; Department of Surgery and Translational Medicine; University of Florence; Firenze Italy
| | - M. Gola
- Allergological and Occupational Dermatology Unit; Department of Surgery and Translational Medicine; University of Florence; Firenze Italy
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24
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Schindler M, Drozdenko G, Kühl AA, Worm M. Immunomodulation in patients with chronic hand eczema treated with oral alitretinoin. Int Arch Allergy Immunol 2014; 165:18-26. [PMID: 25277487 DOI: 10.1159/000365659] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/27/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oral alitretinoin (9-cis-retinoic acid; 9-cis-RA) has shown clinical efficacy in patients with chronic hand eczema (CHE). Herein, we investigated the impact of oral 9-cis-RA on the local and systemic immune response in patients with CHE. METHODS Twenty patients with CHE were treated with oral alitretinoin (10 or 30 mg/day) for at least 24 weeks. Blood samples were taken for flow cytometry, and serum samples were assessed by ELISA to determine immunoglobulin (Ig) levels. Skin biopsies from lesional skin were evaluated immunohistochemically. RESULTS Upon 9-cis-RA treatment, improvement of the CHE was observed in all patients. A significant decrease in plasmablasts in the peripheral blood and a significant reduction of serum IgE levels were determined. Furthermore, we detected a significant reduction of CD4+ cells and regulatory T cells in the peripheral blood upon treatment. By contrast, these cell subsets were significantly increased in the affected skin. Cytokine analysis of activated CD154-positive T cells showed a reduction of interleukin (IL)-17 but not of IL-4 or IFN-γ production. CONCLUSIONS Overall, our data indicate a disease-modifying effect of 9-cis-RA, including a systemic decrease in IL-17-positive cells, but decreased serum IgE and CD23 expression. The increased frequency of FoxP3-positive cells in the skin upon treatment may suggest a mechanism by which hand eczema is therapeutically targeted by 9-cis-RA, but this will need to be proven in the future studies.
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Affiliation(s)
- Mandana Schindler
- Allergy Center Charité, Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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25
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Tan J, Maari C, Nigen S, Bolduc C, Bissonnette R. Open-label exploratory study of acitretin for the treatment of severe chronic hand dermatitis. J DERMATOL TREAT 2014; 26:373-5. [DOI: 10.3109/09546634.2014.952608] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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26
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Lahfa M. [Management of chronic hand eczema]. Ann Dermatol Venereol 2014; 141 Suppl 1:S143-50. [PMID: 24953623 DOI: 10.1016/s0151-9638(14)70151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The management of hand eczema, more readily called chronic hand dermatitis, is complex. This heaviness is related not only to the disease itself by its different clinical forms but also the multiplicity and diversity of etiological factors, triggering / maintaining or aggravating factors. The repeated therapeutic failures are ransom of incorrect information about the disease and its environment, a lack of clarity in the prescription and duration of treatment in general too short. The reference treatment is high potency topical steroids with or without occlusion for 4-8 weeks followed by alitretinoin 30 mg / day for at least 3-6 months with a monthly lipid and liver monitoring and mandatory monthly pregnancy test in women of childbearing. Associated measures and patient education are the cornerstones of successful treatment. Other alternative treatments such as phototherapy, methotrexate, cyclosporin, mycophenolate mofetil etc. can be considered in case of resistance or for clearing followed by topical treatments.
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Affiliation(s)
- M Lahfa
- Service de dermatologie, pôle Spécialités Médicales, hôpital Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France.
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27
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Abstract
Hand eczema is often a chronic, multifactorial disease. It is usually related to occupational or routine household activities. Exact etiology of the disease is difficult to determine. It may become severe enough and disabling to many of patients in course of time. An estimated 2-10% of population is likely to develop hand eczema at some point of time during life. It appears to be the most common occupational skin disease, comprising 9-35% of all occupational diseases and up to 80% or more of all occupational contact dermatitis. So, it becomes important to find the exact etiology and classification of the disease and to use the appropriate preventive and treatment measures. Despite its importance in the dermatological practice, very few Indian studies have been done till date to investigate the epidemiological trends, etiology, and treatment options for hand eczema. In this review, we tried to find the etiology, epidemiology, and available treatment modalities for chronic hand eczema patients.
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Affiliation(s)
| | | | - Rahul Gupta
- Department of Dermatology, SMS Medical College, Jaipur, India
| | - Puneet Agarwal
- Department of Dermatology, Mahatma Gandhi Institute of Medical Sciences, Jaipur, India
| | - Sheetal Napalia
- Department of Dermatology, Mahatma Gandhi Institute of Medical Sciences, Jaipur, India
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28
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Schmitt-Hoffmann AH, Roos B, Schoetzau A, Leese PT, Meyer I, van de Wetering J, Kovacs P. Oral alitretinoin: a review of the clinical pharmacokinetics and pharmacodynamics. Expert Rev Clin Pharmacol 2014; 5:373-88. [DOI: 10.1586/ecp.12.26] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Mollerup A, Johansen J, Thing L. Knowledge, attitudes and behaviour in everyday life with chronic hand eczema: a qualitative study. Br J Dermatol 2013; 169:1056-65. [DOI: 10.1111/bjd.12524] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2013] [Indexed: 12/18/2022]
Affiliation(s)
- A. Mollerup
- National Allergy Research Centre; Department of Dermato-Allergology; Copenhagen University Hospital Gentofte; Niels Andersens Vej 65 DK-2900 Hellerup Denmark
| | - J.D. Johansen
- National Allergy Research Centre; Department of Dermato-Allergology; Copenhagen University Hospital Gentofte; Niels Andersens Vej 65 DK-2900 Hellerup Denmark
| | - L.F. Thing
- Department of Nutrition; Exercise and Sports; Faculty of Science; University of Copenhagen; Nørre Allé 51-55 DK-2200 Copenhagen N Denmark
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30
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Gola M, D’Erme AM, Milanesi N, Marmugi L. Effects of Alitretinoin on Quality of Life of Patients Having Chronic Hand Eczema. Dermatitis 2013; 24:166-9. [DOI: 10.1097/der.0b013e3182987773] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Tejera-Vaquerizo A, Sánchez-Vizcaíno J, Haro-Gabaldón V. Successful Treatment of Recalcitrant Chronic Foot Eczema with Alitertinoin. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:931-2. [DOI: 10.1016/j.adengl.2011.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Accepted: 12/08/2011] [Indexed: 11/28/2022] Open
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Coors EA, von den Driesch P. Treatment of 2 patients with mycosis fungoides with alitretinoin. J Am Acad Dermatol 2012; 67:e265-7. [DOI: 10.1016/j.jaad.2012.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 05/02/2012] [Accepted: 05/08/2012] [Indexed: 11/25/2022]
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Tejera-Vaquerizo A, Sánchez-Vizcaíno J, Haro-Gabaldón V. Tratamiento exitoso de un ezcema crónico recalcitrante de las plantas con alitretinoína. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:931-932. [DOI: 10.1016/j.ad.2011.12.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 11/05/2011] [Accepted: 12/08/2011] [Indexed: 10/28/2022] Open
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Weisshaar E, Kallen U, Weiß M. "The itching hand"- important differential diagnoses and treatment. J Dtsch Dermatol Ges 2012; 11:31-42. [PMID: 23176572 DOI: 10.1111/j.1610-0387.2012.08002.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Skin diseases affecting the hands receive particular individual attention and constitute a considerable emotional burden. Many dermatoses also present with itching of the hands. Itch is often underestimated when it occurs in a comparably limited body area such as the hands. The high occupational significance of the hands in many professions must, nevertheless, be stressed. One of the most frequent diagnoses in itching of the hands is eczema. In the differential diagnosis, less common diseases such as neurological and systemic diseases and adverse drug reactions must also be taken into consideration. Itching of the hands can also be accompanied by other sensations, such as burning, stinging and pain. A thorough history regarding sensations and dysesthesias already allows for a diagnostic classification of the disease in some cases. Itching of the hands requires a careful and thorough diagnostic approach. This forms the basis of a specific and successful therapy which may be adapted stepwise, depending on the underlying cause, and also may require, in addition to causal therapy, symptomatic antipruritic therapy. Therapy should follow the current guidelines for chronic pruritus and hand eczema. This article reviews over the differential diagnosis and therapy of "itching hands".
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Affiliation(s)
- Elke Weisshaar
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Germany.
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35
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Greenberger S, Harats D, Salameh F, Lubish T, Harari A, Trau H, Shaish A. 9-cis–Rich β-Carotene Powder of the AlgaDunaliellaReduces the Severity of Chronic Plaque Psoriasis: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Am Coll Nutr 2012; 31:320-6. [DOI: 10.1080/07315724.2012.10720430] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Baumeister T, Uter W, Weistenhöfer W, Drexler H, Kütting B. On the lookout for precursor lesions: where does dry skin end and slight hand eczema begin? Contact Dermatitis 2011; 66:63-71. [DOI: 10.1111/j.1600-0536.2011.01969.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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38
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Schmitt-Hoffmann AH, Roos B, Sauer J, Brown T, Weidekamm E, Meyer I, Schleimer M, Maares J. Low levels of alitretinoin in seminal fluids after repeated oral doses in healthy men. Clin Exp Dermatol 2011; 36 Suppl 2:12-7. [PMID: 21443599 DOI: 10.1111/j.1365-2230.2011.04032.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alitretinoin, like all retinoids, is teratogenic, and can only be given to women of childbearing potential if pregnancy is excluded and a strict contraceptive programme is followed. AIM This study was designed to determine whether alitretinoin in the semen of men treated with alitretinoin poses a teratogenic risk to their female partners. METHODS In total, 24 healthy men aged 18-45 years received alitretinoin 20 mg (n = 12) or 40 mg (n = 12), once daily for 14 days. Subjects in the 40 mg dose group provided ejaculate at baseline, on day 1, before and approximately 4 h after dosing on day 2, and at follow-up on study day 21 (± 2). RESULTS Alitretinoin and 4-oxo-alitretinoin were detected in 11 of the 12 semen samples. The highest level of alitretinoin in semen was 7.92 ng/mL. Assuming an ejaculate volume of 10 mL, the amount of drug transferred in semen would be about 80 ng, 1/375,000 of a single 30 mg capsule. Complete absorption of 80 ng of alitretinoin from semen, presuming a volume of distribution confined to 5 L of circulating blood in the partner, would lead to an increase in plasma alitretinoin concentration of 0.016 ng/mL, which appears to be negligible compared with measured endogenous plasma levels. Increases in plasma levels of related retinoids are also negligible. CONCLUSIONS Alitretinoin in the semen of men receiving up to 40 mg of oral alitretinoin per day is unlikely to be associated with teratogenic risk in their female partners. Barrier contraception is therefore not required for men taking alitretinoin.
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Schmitt-Hoffmann AH, Roos B, Sauer J, Spickermann J, Maares J, Schoetzau A, Meyer I. Pharmacokinetic interactions between alitretinoin and ketoconazole or simvastatin or ciclosporin A. Clin Exp Dermatol 2011; 36 Suppl 2:24-8. [DOI: 10.1111/j.1365-2230.2011.04034.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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