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Axler EN, Lipner SR. Nail lichen planus treatment safety. Expert Opin Drug Saf 2023; 22:1157-1168. [PMID: 38014463 DOI: 10.1080/14740338.2023.2288902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/24/2023] [Indexed: 11/29/2023]
Abstract
AREAS COVERED Topical therapies for nail lichen planus (clobetasol propionate, topical tacrolimus, bath-PUVA), intralesional treatment (triamcinolone), and systemic treatment (corticosteroids, retinoids, small molecule inhibitors (jak/stat inhibitors)), TNF-alpha inhibitors (etanercept), systemic immunomodulators (oral calcineurin inhibitors, mycophenolate mophetil), and antimalarials (chloroquine), each with unique safety profiles and considerations. Herein, we discuss common and uncommon adverse events, as well as utilization for special populations, including pregnant and pediatric patients.
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Affiliation(s)
- Eden N Axler
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shari R Lipner
- Weill Cornell Medicine, Department of Dermatology, New York, NY, USA
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Dubin C, Del Duca E, Guttman-Yassky E. Drugs for the Treatment of Chronic Hand Eczema: Successes and Key Challenges. Ther Clin Risk Manag 2020; 16:1319-1332. [PMID: 33408476 PMCID: PMC7780849 DOI: 10.2147/tcrm.s292504] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic hand eczema (CHE) is a common and burdensome inflammatory skin condition seen in up to 10% of the population, more often in high-risk occupational workers. Topical therapeutics comprise the standard of care, but up to 65% of cases do not resolve after treatment, and moderate-to-severe cases are often resistant to topical therapeutics and require systemic options instead. To date, there are no systemic therapeutics approved to treat CHE in the United States, but several drugs are under investigation as potential treatments for CHE. The primary focus of this review is on the novel therapeutics, topical and systemic, that are under investigation in recently completed or currently ongoing trials. This review also briefly outlines the existing treatments utilized for CHE, often with limited success or extensive adverse effects. CHE represents a major challenge for physicians and patients alike, and efforts to improve the minimally invasive diagnostic tools and treatment paradigms are ongoing. In the near future, CHE patients may benefit from new topical and systemic therapeutics that specifically target abnormally expressed immune markers.
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Affiliation(s)
- Celina Dubin
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ester Del Duca
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Dermatology, University of Magna Graecia, Catanzaro, Italy
| | - Emma Guttman-Yassky
- Department of Dermatology, Laboratory of Inflammatory Skin Diseases, 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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Khademi A, Mansuri P, Pahlevan D, Bozorgi M, Nasiri M, Hejazi S, Azizian Z, Shirbeigi L. Efficacy of Pumpkin Ointment in Treatment of Chronic Hand Eczema: A Randomized, Active-Controlled, Double Blind Clinical Trial. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1339-1347. [PMID: 33083301 PMCID: PMC7548497 DOI: 10.18502/ijph.v49i7.3588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Hand Eczema (HE) is chronic skin disease with a high prevalence in population. It has negative impact on the quality of life. Due to the public interest in herbal remedies, we attempt to assess the efficacy of pumpkin ointment in treatment of chronic HE in this research. Methods This study was conducted in an outpatient clinic at Imam-Khomeini Hospital in Tehran (Iran) from May 2015 to Nov 2016. We performed a double-blind trial on 60 patients with chronic HE randomized to four groups included pumpkin, betamethasone, eucerin and almond ointment (n=15 for each group) for 28 days. Patients were ordered to apply ointments twice a day. Hand Eczema Severity Index (HECSI) and Dermatology Life Quality Index (DLQI) of the patients were evaluated by a dermatologist on the 1st, 14th and 28th d after the start of treatment. Results Patients' DLQI scores in pumpkin and betamethasone group was significant and pumpkin group showed a better response in quality of life (P=0.001). Betamethasone and pumpkin ointment were effective and showed significant improvement compared with almond and eucerin and reduce HECSI scores (P=0.002 and P=0.012 respectively). Betamethasone ointment outcome on HECSI scores in comparison with topical pumpkin was significant (P<0.001). No clinically adverse effects were observed. Conclusion Although pumpkin ointment showed a better response in patients' DLQI in HE but it was less effective than betamethasone in decreasing HECSI.
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Affiliation(s)
- Alemeh Khademi
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Parvin Mansuri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Daryoush Pahlevan
- Research Center for Social Determinants of Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Mahbubeh Bozorgi
- Department of Traditional Pharmacy, School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Biostatistics, School of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Hejazi
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Azizian
- Department of Dermatology, Iran University of Medical Sciences, Tehran, Iran
| | - Laila Shirbeigi
- Department of Traditional Medicine, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Jo M, Kang HS, Kim MS, Park HJ, Jue MS. Efficacy and Safety of Alitretinoin Therapy in Korean Elderly Patients with Chronic Hand Eczema: A Retrospective Single Center Study. Ann Dermatol 2019; 31:595-600. [PMID: 33911658 PMCID: PMC7992595 DOI: 10.5021/ad.2019.31.6.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/24/2019] [Accepted: 07/31/2019] [Indexed: 11/16/2022] Open
Abstract
Background Chronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that alitretinoin is an effective and well-tolerated treatment for CHE. However, there is a relative lack of data on the effectiveness of alitretinoin in elderly patients. Objective The aim of this study was to investigate the efficacy and safety of oral alitretinoin in elderly patients with moderate to severe CHE in Korea. Methods We retrospectively investigated 46 CHE patients who were treated with either 10 mg or 30 mg of alitretinoin between June of 2016 and July of 2018. The physician's global assessment (PGA) was used to evaluate treatment efficacy. All adverse events were retrospectively evaluated with respect to laboratory testing, including complete blood cell count, fasting blood chemistry, lipid profile, and liver and thyroid function tests. Results The mean patient age in this study was 71.0±5.1 years. The treatment period was over eight weeks. A total of 38 of 46 patients (82.6%) exhibited clinical improvement with PGA ratings of ‘clear’ or ‘almost clear.’ There were 13 patients (28.3%) who experienced an adverse effect, with the most common being headache (13.0%) and gastrointestinal symptoms (8.7%) followed by xerosis (6.5%). A total of 13 patients developed or exhibited worsening hypertriglyceridemia (28.3%). Conclusion Alitretinoin can be considered a safe and effective treatment option in elderly patients with moderate to severe CHE.
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Affiliation(s)
- Mingyul Jo
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - Ho Song Kang
- Division of Dermatology, Department of Medicine, Hanyang University Graduate School, Seoul, Korea
| | - Min-Soo Kim
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyang-Joon Park
- Department of Dermatology, Gachon University of Medicine and Science, Incheon, Korea
| | - Mihn-Sook Jue
- Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea
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Al-Dhubaibi MS, Settin AA. The effectiveness of alitretinoin for the treatment of chronic hand eczema: A meta-analysis. Int J Health Sci (Qassim) 2018; 12:70-79. [PMID: 29599698 PMCID: PMC5870332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Alitretinoin is a new oral retinoid authorized for use in grownups that have severe chronic hand eczema (CHE). A comprehensive search to solicit all studies of alitretinoin for the treatment of CHE. A comprehensive search to solicit all studies of alitretinoin for the treatment of CHE including randomized controlled trials (RCTs) or uncontrolled trials, re-treatment studies, open-label studies, or observational studies, along with case series of 10 or more participants. Physician global assessment (PGA), patient global assessment (PaGA) and modified total lesion symptom score (mTLSS) are the methods and outcomes criteria. Generated effect size and 95% confidence intervals were calculated for the outcomes. Heterogeneity and publication bias were also tested for all selected trials. When a noteworthy Q statistic (P < 0.1) demonstrates the heterogeneity crosswise over studies, an arbitrary impact model is used. On the other hand, a settled effect model is when heterogeneity is not shown. The initial search yielded 408 records of which 15 articles were selected. The 15 clinical trials included 3734 patients with CHE. Among alitretinoin-treated patients, the PGA effect size was directly proportional to the drug dosage, ranging from 40% to 69%, while the PaGA score ranged from 28.8% to 62.4%, and mTLSS ranged from 60.4% to 76.9%, much higher than placebo. A higher drug dose was about twice as effective as lower dose. The odds ratio for a better outcome with drug treatment taking duration into account was about 3-4 times that versus placebo. In conclusions, alitretinoin cleared lesions in about 50% of cases, particularly using a higher dose for a longer duration.
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Affiliation(s)
- Mohammed Saleh Al-Dhubaibi
- Department of Dermatology, College of Medicine, Qassim University, Saudi Arabia,Address for correspondence: Mohammed Saleh Al-Dhubaibi, Department of Dermatology, College of Medicine, Qassim University, PO Box 064, Buraidah 51431, Saudi Arabia. E-mail:
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MANSOURI P, KHADEMI A, PAHLEVAN D, MEMARIANI Z, ALIASL J, SHIRBEIGII L. Review of Medicinal Remedies on Hand Eczema Based on Iranian Traditional Medicine: A Narrative Review Article. IRANIAN JOURNAL OF PUBLIC HEALTH 2016; 45:986-996. [PMID: 27928524 PMCID: PMC5139979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Hand Eczema (HE) is a dermatological disorder with frequent relapses and multiple causes such as atopic, allergic and irritant contact dermatitis. The management is complex because of the wide range of different pathogenesis. Efficacy of some of available treatments is not well established and it can affect patients' quality of life significantly. METHODS Reports on HE such as diagnosis, pathophysiology, pharmacological and nonpharmacological therapy that described in medieval Iranian medicine, were gathered and analyzed from selected medical and pharmaceutical textbooks of Iranian Traditional Medicine (ITM). The search of databases such as PubMed, EMBASE/Excerpta Medica, Science direct, Scopus, Google scholar, Web of science, Sid, Iran medex, Irandoc, was performed to reconfirm the efficacy of ITM remedies in conventional medicine from 1980-Jan-1 to 2015-Dec-30. RESULTS According to their opinion, HE is highly associated with liver function. This disorder was categorized into two main types as wet and dry ones. Most Iranian textbook explained signs of HE, as excessive skin itching, redness, burning and dryness. Treatments recommended by Iranian scientists were lifestyle modification, dietary intervention and performing the rules of prevention as well as herbal therapy and special manipulations. CONCLUSION Iranian practitioners believed that, six essential principles, diet therapy and medicinal plants have high impact on treatment of HE. These remedies based on Iranian scholar's experiences might be useful for further studies to the management of HE.
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Affiliation(s)
- Parvin MANSOURI
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aleme KHADEMI
- Dept. of Iranian Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Daryoush PAHLEVAN
- Research Center for Social Determinants of Health, Semnan University of Medical Sciences, Semnan, Iran
| | - Zahra MEMARIANI
- Dept. of Traditional Pharmacy, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jale ALIASL
- The Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Laila SHIRBEIGII
- Dept. of Iranian Traditional Medicine, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
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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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