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Otrofanowei E, Ayanlowo OO, Akinkugbe AO, Oresanya FA. Management Outcomes of Hand Dermatitis in a Tertiary Hospital in Southwest Nigeria. Niger J Clin Pract 2023; 26:1734-1741. [PMID: 38044781 DOI: 10.4103/njcp.njcp_354_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/10/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Hand dermatitis (HD) is inflammation of the skin of the hands. It ranges in severity and has a significant impact on quality of life (QoL). The physical and psychosocial burden of the disease is comparable with psoriasis in impairment of the QoL of the patient and depression. Quality of life correlates with disease severity. AIM To evaluate the management outcome of HD with a disease severity tool by the physician and quality of life index. MATERIALS AND METHODS This was a cross-sectional study of a cohort of patients with HD over 24 weeks in the dermatology clinic of a tertiary hospital in Nigeria. Disease severity and quality of life were measured using the physician global assessment (PGA) and dermatology life quality index (DLQI), respectively. These were re-administered 6 weeks after treatment. Results were collated and analyzed. RESULTS One hundred and seventy-seven (13.3%) of 1,329 patients had HD with F/M ratio of 1.2: 1; a mean age of 34.6 ± 7.4 years. Comparing PGA scores at baseline and 6 weeks, a statistically significant improvement was noted P < 0.001. The mean DLQI score at baseline was 10.38 and reduced to 3.02 post-treatment. The difference between the two means of the DLQI was ≥5 from baseline signifying improved quality of life. The domain of symptoms and feelings was the most affected at baseline and most improved afterward. CONCLUSION HD has a significant impact on its sufferers and this correlates with disease severity. Appropriate management improves disease outcome and patients' quality of life.
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Affiliation(s)
- E Otrofanowei
- Department of Medicine, College of Medicine University of Lagos/ Lagos University Teaching Hospital, Ikoyi, Lagos, Nigeria
| | - O O Ayanlowo
- Department of Medicine, College of Medicine University of Lagos/ Lagos University Teaching Hospital, Ikoyi, Lagos, Nigeria
| | - A O Akinkugbe
- Department of Medicine, College of Medicine University of Lagos/ Lagos University Teaching Hospital, Ikoyi, Lagos, Nigeria
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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 2023. [PMID: 37870578 DOI: 10.1089/derm.2023.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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Napolitano M, Potestio L, De Lucia M, Nocerino M, Fabbrocini G, Patruno C. Alitretinoin for the treatment of severe chronic eczema of the hands. Expert Opin Pharmacother 2021; 23:159-167. [PMID: 34789049 DOI: 10.1080/14656566.2021.1998457] [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: 10/19/2022]
Abstract
INTRODUCTION Chronic hand eczema (CHE) is a frequent skin disorder affecting up to 10% of the population and strongly reduces Quality of Life (QoL). The first-line therapeutic strategies for the management of CHE include a change of lifestyle, an education program for the skin and the application of specific emollients. Topical corticosteroids or calcineurin inhibitors are the most used anti-inflammatory drugs. However, up to 65% of patients require systemic options. Alitretinoin, a retinoid structurally related to vitamin A, is the first systemic treatment approved in the European Union (EU) for severe CHE refractory to potent topical corticosteroids. AREAS COVERED This review summarizes the available data on the pharmacokinetics, pharmacodynamics, efficacy, and safety profile of oral alitretinoin for the treatment of CHE. EXPERT OPINION Alitretinoin can be considered as a valid therapeutic option for the treatment of CHE in patients not responding to ordinary treatments. Clinical trials and real-life experiences showed that it acts effectively on both objective and subjective clinical signs, resulting in a significant improvement in QoL of patients. As for other retinoids, caution should be taken in patients with certain chronic diseases (hepatopathies, kidney failure, hyperlipidemia, thyroid dysfunction) or childbearing potential women.
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Affiliation(s)
- Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Mario De Lucia
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Mariateresa Nocerino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico Ii, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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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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Maden S, Ozbagcivan O, Onur Aysevener BE, Aktan S. Quality of life, anxiety, depression, social anxiety and avoidance in patients with chronic hand eczema. Ital J Dermatol Venerol 2021; 156:562-569. [PMID: 33913662 DOI: 10.23736/s2784-8671.21.06645-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Previous studies have demonstrated that chronic hand eczema (CHE) causes negative effects on psychological status of patients. However, presence of social anxiety and avoidance has not been investigated in CHE patients. In this descriptive and prospective study, we aimed to examine the psychosocial dimensions of CHE in a more detailed manner. METHODS 70 patients with CHE and 70 controls were participated in the study. The quality of life (QoL) was assessed with the World Health Organization QoL Questionnaire-Short Form (WHOQoL-BREF); anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS); and social anxiety and avoidance were evaluated with the Liebowitz Social Anxiety Scale (LSAS). RESULTS The physical and environmental subscale scores of the WHOQoL-BREF were significantly lower (P<0.001, P=0.041); whereas HADS-total (P=0.019), HADSanxiety (P=0.014), LSAS-total (P=0.025), LSAS-anxiety (P=0.037) and LSASavoidance (P=0,029) scores were significantly higher in CHE patients compared to controls. The physical (r=-0.260, p=0.002) and social (r=0.204, p=0.016) domains of the WHOQoL-BREF scale negatively correlated with the severity of eczema, while the psychological (r=-0.363, p=0.002) and environmental (r=-0.456, p<0.001) domains negatively correlated with the extent of eczema. HADS-total (r=0.284, p=0.017) and HADS-depression (r=0.311, p=0.009) also showed positive correlations with the extent of the CHE. CONCLUSIONS Considering that impairment in QoL may be associated with psychosocial morbidity, it is important to develop strategies to recognize and treat those psychiatric comorbidities in patients with CHE.
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Affiliation(s)
- Serap Maden
- Department of Dermatology, Faculty of Medicine, Near East University, Nicosia, North Cyprus, Turkey -
| | - Ozlem Ozbagcivan
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | | | - Sebnem Aktan
- Department of Dermatology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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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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Seol JE, Kim JU, Hong SM, Cho GJ, Jin WJ, Park SH, Park IH, Jung SY, Kim H. Alitretinoin Compliance in Patients with Chronic Hand Eczema. Ann Dermatol 2020; 33:46-51. [PMID: 33911811 PMCID: PMC7875224 DOI: 10.5021/ad.2021.33.1.46] [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: 04/24/2020] [Revised: 07/20/2020] [Accepted: 08/13/2020] [Indexed: 11/08/2022] Open
Abstract
Background Oral alitretinoin is effective in the treatment of chronic hand eczema (CHE), and ≥12 weeks of alitretinoin treatment has been shown to be effective in Korean patients. However, in the real world, a considerable number of patients discontinue alitretinoin, which leads to treatment failure. Objective To evaluate the compliance rate of alitretinoin treatment and explore common reasons for poor compliance in patients with CHE in the real world. Methods We retrospectively reviewed the electronic medical records of CHE patients treated with alitretinoin. We defined ‘poor-compliance’ as subjects who were treated with alitretinoin for <12 weeks and ‘good-compliance’ as subjects who were treated with alitretinoin for ≥12 weeks. We reviewed the demographics, dose, and duration of alitretinoin usage, efficacy, and reasons for poor compliance. Results A total of 137 subjects were enrolled, and 77 (56.2%) did not complete the 12-week treatment with alitretinoin. Among them, the non-improvement rate was significantly higher in the poor-compliance group than in the good-compliance group (p<0.01). The main reasons for the alitretinoin cessation in the poor-compliance group were insufficient response (40.8%), followed by high cost (34.7%), and adverse events (24.5%). Conclusion Alitretinoin appears the preferred long-term treatment option for CHE. Although there are complaints about late efficacy, cost, and side effects, following proper explanation, these should not justify discontinuation. Physicians need to recognize the reasons for poor compliance with alitretinoin for each patient and suggest continuing alitretinoin for the successful treatment of CHE.
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Affiliation(s)
- Jung Eun Seol
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.,Cardiovascular and Metabolic Disease Center, Inje University, Busan, Korea
| | - Jong Uk Kim
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Seong Min Hong
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Gyeong Je Cho
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Woo Jung Jin
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - So Hee Park
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - In Ho Park
- Department of Dermatology, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - So Young Jung
- Department of Dermatology, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hyojin Kim
- Department of Dermatology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
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Juntongjin P, Chunhakham P. Synergistic Effects of the 308-nm Excimer Light and Topical Calcipotriol for the Treatment of Chronic Hand Eczema: A Randomized Controlled Study. Dermatology 2020; 237:31-38. [PMID: 31982887 DOI: 10.1159/000505539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Though topical corticosteroid is a standard treatment for chronic hand eczema (CHE), it can cause many adverse effects. Topical calcipotriol and monochromatic 308-nm excimer light (MEL) are new alternative therapies for several dermatoses, including CHE. OBJECTIVE This study aims to compare the efficacy of the combination of MEL and topical calcipotriol versus topical calcipotriol alone. METHODS One hand of the participants was randomly assigned to be irradiated with MEL twice weekly and topical calcipotriol applied twice daily while the other hand was assigned to receive only topical calcipotriol twice daily for 8 weeks. Then, only petrolatum ointment was applied during the 4-week follow-up period. Hand Eczema Severity Index (HECSI) and modified Total Lesion Symptom Score were assessed by a blinded investigator, and a visual analogue scale score of itching symptoms was graded by the participants. RESULTS In total, 36 hands from 18 subjects completed the protocol. On the combination-treated sides, the mean HECSI score was significantly reduced by 25% (p = 0.015) from the 4th week. Then, it was gradually decreased to 57 and 65% (p < 0.001) at the 8th week and at the follow-up visit, respectively. For the monotherapy-treated sides, the mean HECSI score was reduced to 41% (p = 0.001) and 49% (p < 0.001) at the 8th and 12th week, accordingly. At the end of the treatment period, itching scores were significantly decreased by around 64% (p < 0.001) and 51% (p = 0.002) on the combination-treated and the monotherapy-treated sides. No serious and persistent adverse reactions were found. CONCLUSION The combined MEL and topical calcipotriol may be considered as an alternatively effective treatment for CHE.
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Affiliation(s)
- Premjit Juntongjin
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand,
| | - Pradtana Chunhakham
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
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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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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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Lee JS, Park HS, Yoon HS, Cho S. Efficacy and Safety of Oral Alitretinoin in Hand Eczema and Palmoplantar Pustulosis in Korean Patients. Ann Dermatol 2019; 31:139-145. [PMID: 33911562 PMCID: PMC7992670 DOI: 10.5021/ad.2019.31.2.139] [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: 05/29/2018] [Revised: 09/05/2018] [Accepted: 10/04/2018] [Indexed: 01/29/2023] Open
Abstract
Background Previous studies have demonstrated efficacy and safety of oral alitretinoin in hand eczema (HE) whereas in palmoplantar pustulosis (PPP), which can be difficult to distinguish from HE, efficacy of alitretinoin is still controversial. Objective This study aimed to investigate the efficacy and safety of oral alitretinoin in HE and PPP and factors that affect the response of these disorders to alitretinoin. Methods We retrospectively analyzed Korean adult patients with moderate-to-severe HE and PPP treated with oral alitretinoin, 46 patients for efficacy assessment and 55 patients for safety assessment. Results Among 46 patients who were treated with alitretinoin for at least 1 month, 29 patients (61.1% in HE and 40.0% in PPP) showed response to alitretinoin in the median 14 weeks after treatment. Hyperkeratotic HE showed higher response rate than either vesicular HE or PPP (p=0.026 and p=0.026, respectively). However, PPP with hyperkeratotic features showed as much response as hyperkeratotic HE (p=0.554). When responders and non-responders in total patients were compared, morphology, not diagnosis or initial severity, was the only significantly different factor between the two groups. After alitretinoin discontinuation in responders, relapse rate was 63.6% (7/11) and median time to relapse was 150 days (range, 76~730 days). Adverse events occurred in 47.3% (26/55); however, there were no serious adverse events. Conclusion In HE or PPP, lesions with hyperkeratotic morphology can be predicted to respond well to alitretinoin regardless of diagnosis.
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Affiliation(s)
- Ji Su Lee
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University, Seoul, Korea.,Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
| | - Hyun-Sun Park
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University, Seoul, Korea.,Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University, Seoul, Korea.,Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea
| | - Soyun Cho
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Institute of Human-Environmental Interface Biology, Medical Research Center, Seoul National University, Seoul, Korea.,Department of Biomedical Science, Seoul National University Graduate School, Seoul, Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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