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Ferrucci S, Persichini P, Gola M, Scandagli I, Pigatto P, Legori A, Musumeci ML, Micali G, D'Agata E, Schena D, Azzolini A, Gallo R, Trave I, Cristaudo A, Patruno C, Napolitano M, Zucca M, Piras V, Stingeni L, Bianchi L, Corazza M, Zedde P, Foti C, Romita P, Cannavò SP, Guarneri F. DECISA Project (DErmatology Clinics in Italy: Survey on Alitretinoin): A real-life retrospective cohort multicenter study on 438 subjects with chronic hand eczema. Dermatol Ther 2021; 34:e14911. [PMID: 33619833 DOI: 10.1111/dth.14911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/06/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
Alitretinoin is the only systemic agent approved to treat moderate-severe chronic hand eczema (CHE) unresponsive to potent topical corticosteroids. No nationwide Italian data regarding real-life efficacy, safety, and tolerability of treatment are available. The DECISA project (DErmatology Clinics in Italy: Survey on Alitretinoin) retrospectively examined data from a registry including 15 Dermatology Clinics authorized to prescription of alitretinoin for CHE patients. Disease severity was assessed at baseline, and after 3 and 6 months of treatment, using the 5-point Physician Global Assessment (PGA) and the modified Total Lesion-Symptoms-Severity (mTLSS) scores. Between November 2010 and July 2018, data of 248 male and 190 female patients (mean age 49.71 ± 13.20 years) treated with alitretinoin were collected. Of them, 43.2% had irritant contact dermatitis, 22.2% allergic contact dermatitis, 18.0% atopic dermatitis, 16.7% mixed (irritant/allergic) type of eczema. At 3 months, the 420 re-evaluated patients showed significantly reduced mTLSS and PGA (P < .0000001 vs baseline for both); PGA was clear/almost clear in 35.6% of cases. At 6 months, the 341 re-evaluated patients showed significant (P < .0000001) improvement of mTLSS and PGA vs baseline and 3 months (PGA clear/almost clear: 41.4%). Relapses occurred in 125 patients; 58 underwent an additional course of alitretinoin, with similarly good results. No relevant safety issues were reported; 86 patients experienced adverse effects, which forced 40 to prematurely stop treatment. The DECISA project results confirm the real-life efficacy, safety and tolerability of alitretinoin in the treatment of moderate to severe CHE refractory to standard topical therapies.
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Affiliation(s)
- Silvia Ferrucci
- U.O.C. Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Paola Persichini
- U.O.C. Dermatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Massimo Gola
- SAS di Dermatologia Allergologica e Professionale-AUSL Toscana Centro e Università degli Studi di Firenze, Florence, Italy
| | - Ilaria Scandagli
- SAS di Dermatologia Allergologica e Professionale-AUSL Toscana Centro e Università degli Studi di Firenze, Florence, Italy
| | - Paolo Pigatto
- UO Dermatologia IRCCS Ospedale Galeazzi & Università degli Studi di Milano, Milan, Italy
| | - Agostina Legori
- UO Dermatologia IRCCS Ospedale Galeazzi & Università degli Studi di Milano, Milan, Italy
| | - Maria Letizia Musumeci
- Dermatology Clinic, University of Catania, PO G. Rodolico, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Giuseppe Micali
- Dermatology Clinic, University of Catania, PO G. Rodolico, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Elisabetta D'Agata
- Dermatology Clinic, University of Catania, PO G. Rodolico, AOU Policlinico-Vittorio Emanuele, Catania, Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Alan Azzolini
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Rosella Gallo
- Clinica Dermatologica-DISSAL, Università di Genova e Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Ilaria Trave
- Clinica Dermatologica-DISSAL, Università di Genova e Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Antonio Cristaudo
- UOSD Dermatologia MST, Ambientale, Tropicale e Immigrazione Istituto Dermatologico San Gallicano (IRCCS), Rome, Italy
| | - Cataldo Patruno
- Unit of Dermatology, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maddalena Napolitano
- Department of Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Myriam Zucca
- Dermatologic Clinic, Hospital S. Giovanni di Dio, Cagliari, Italy
| | - Viviana Piras
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine, University of Perugia, Italy
| | - Leonardo Bianchi
- Dermatology Section, Department of Medicine, University of Perugia, Italy
| | - Monica Corazza
- Sezione di Dermatologia, Dipartimento di Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Pierantonia Zedde
- Sezione di Dermatologia, Dipartimento di Scienze Mediche, Università di Ferrara, Ferrara, Italy
| | - Caterina Foti
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Clinica Dermatologica, Bari, Italy
| | - Paolo Romita
- Dipartimento di Scienze Biomediche ed Oncologia Umana, Clinica Dermatologica, Bari, Italy
| | | | - Fabrizio Guarneri
- Dipartimento di Medicina Clinica e Sperimentale-Dermatologia, Università di Messina, Messina, Italy
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Silvestre Salvador JF, Heras Mendaza F, Hervella Garcés M, Palacios-Martínez D, Sánchez Camacho R, Senan Sanz R, Apellaniz González A, Giménez-Arnau AM. Guidelines for the Diagnosis, Treatment, and Prevention of Hand Eczema. ACTAS DERMO-SIFILIOGRAFICAS 2021; 111:26-40. [PMID: 32197684 DOI: 10.1016/j.ad.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/11/2019] [Accepted: 04/21/2019] [Indexed: 12/28/2022] Open
Abstract
Hand eczema is a common condition associated with significantly impaired quality of life and high social and occupational costs. Managing hand eczema is particularly challenging for primary care and occupational health physicians as the condition has varying causes and both disease progression and response to treatment are difficult to predict. Early diagnosis and appropriate protective measures are essential to prevent progression to chronic eczema, which is much more difficult to treat. Appropriate referral to a specialist and opportune evaluation of the need for sick leave are crucial to the good management of these patients. These guidelines cover the diagnosis, prevention, and treatment of chronic hand eczema and highlight the role that primary care and occupational health physicians can play in the early management of this disease.
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Affiliation(s)
| | - F Heras Mendaza
- Servicio de Dermatología, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - M Hervella Garcés
- Servicio de Dermatología, Complejo Hospitalario de Navarra, Pamplona, España
| | - D Palacios-Martínez
- Medicina de Atención Primaria, Centro de Salud Isabel II, Parla, Madrid, España
| | | | - R Senan Sanz
- Equipo de Atención Primaria el Clot, Instituto Catalán de la Salud, Barcelona, España
| | - A Apellaniz González
- Departamento de Estomatología, Facultad de Medicina y Enfermería, Euskal Herriko Unibertsitatea-Universidad del País Vasco, Leioa, Bizkaia, España
| | - A M Giménez-Arnau
- Departamento de Dermatología, Hospital del Mar, Universitat Autónoma de Barcelona, Barcelona, España
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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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Crowley EL, Sayeau RL, Gooderham MJ. An Update on the Use of Alitretinoin for Chronic Hand Dermatitis in a Dermatology Practice Setting. J Cutan Med Surg 2018; 22:102-103. [DOI: 10.1177/1203475417733914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erika L. Crowley
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Trent University, Peterborough, ON, Canada
| | - Rachael L. Sayeau
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Trent University, Peterborough, ON, Canada
| | - Melinda J. Gooderham
- SKiN Centre for Dermatology, Peterborough, ON, Canada
- Queen’s University, Kingston, ON, Canada
- Probity Medical Research, Waterloo, ON, Canada
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Yang M, Chang JM. Successful treatment of refractory chronic hand eczema with calcipotriol/betamethasone ointment: A report of three cases. Exp Ther Med 2015; 10:1943-1946. [PMID: 26640577 DOI: 10.3892/etm.2015.2729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 07/28/2015] [Indexed: 02/07/2023] Open
Abstract
Chronic hand eczema (CHE) is a common skin disorder with frequent relapses, and its treatment comprises a challenge due to its uncertain etiology. In particular, certain cases of CHE exhibiting severe keratinization have a very poor response to various treatments. The Daivobet ointment, a complex product comprising calcipotriol and betamethasone, has been successfully used for the treatment of patients with plaque-type psoriasis for ~10 years; however, there are few reports on the effect of the ointment on other skin disorders of abnormal keratinization, such as eczema. The present study reported 3 cases of refractory hyperkeratotic eczema of the hand that did not respond to several treatments, but responded well to topical Daivobet treatment.
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Affiliation(s)
- Min Yang
- Department of Dermatology, Beijing Hospital, Beijing 100730, P.R. China
| | - Jian-Min Chang
- Department of Dermatology, Beijing Hospital, Beijing 100730, P.R. China
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de León FJ, Berbegal L, Silvestre JF. Management of Chronic Hand Eczema. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:533-44. [PMID: 26005193 DOI: 10.1016/j.ad.2015.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/16/2015] [Accepted: 04/15/2015] [Indexed: 11/17/2022] Open
Abstract
Management of hand eczema is complex because of the broad range of different pathogeneses, courses, and prognoses. Furthermore, the efficacy of most available treatments is not well established and the more severe forms can have a major impact on the patient's quality of life. Patient education, preventive measures, and the use of emollients are the mainstays in the management of hand eczema. High-potency topical corticosteroids are the treatment of choice, with calcineurin inhibitors used for maintenance. Phototherapy or systemic treatments are indicated in patients who do not respond to topical treatments. Switching from topical treatments should not be delayed to avoid sensitizations, time off work, and a negative impact on quality of life. Alitretinoin is the only oral treatment approved for use in chronic hand eczema.
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Affiliation(s)
- F J de León
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España.
| | - L Berbegal
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España
| | - J F Silvestre
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España
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