Conflicts of interest R.B., M.W., B.G., L.G., F.C. and T.R. are investigators in Basilea clinical trials. R.B. and T.R. are consultants for Basilea Pharmaceutica International Ltd. J.M. and T.C.B. are employees of Basilea Pharmaceutica International Ltd.
Successful retreatment with alitretinoin in patients with relapsed chronic hand eczema
Article first published online: 10 NOV 2009
© 2009 The Authors. Journal Compilation © 2009 British Association of Dermatologists
British Journal of Dermatology
Volume 162, Issue 2, pages 420–426, February 2010
How to Cite
Bissonnette, R., Worm, M., Gerlach, B., Guenther, L., Cambazard, F., Ruzicka, T., Maares, J. and Brown, T.C. (2010), Successful retreatment with alitretinoin in patients with relapsed chronic hand eczema. British Journal of Dermatology, 162: 420–426. doi: 10.1111/j.1365-2133.2009.09572.x
- Issue published online: 13 JAN 2010
- Article first published online: 10 NOV 2009
- Accepted for publication 28 October 2009
- chronic hand eczema;
- 9-cisretinoic acid
Summary Background Patients with severe chronic hand eczema (CHE) often respond to therapy with oral alitretinoin (9-cis retinoic acid). However, the efficacy of alitretinoin after disease relapse has not been demonstrated.
Objectives To assess the efficacy and safety of a second course of oral alitretinoin in patients with severe CHE who relapsed after achieving ‘clear’ or ‘almost clear’ hands following a previous course of alitretinoin.
Methods The double-blind study included 117 patients with CHE who had responded to therapy in an earlier clinical trial and subsequently relapsed. Patients were randomized to receive their previous treatment or placebo. Treatment was alitretinoin 30 mg or 10 mg or placebo given once daily for 12–24 weeks. Response was defined as an overall Physician’s Global Assessment rating of ‘clear’ or ‘almost clear’ hands at the end of therapy.
Results Response rates were 80% in patients retreated with 30 mg alitretinoin compared with 8% for placebo (P < 0·001). In patients retreated with 10 mg alitretinoin response rates were 48%, compared with 10% in the placebo group. Alitretinoin was well tolerated. Adverse reactions comprised typical retinoid class effects, and no late-arising side-effects were observed during this second course of treatment.
Conclusions The majority of patients with CHE who previously achieved ‘clear’ or ‘almost clear’ hands following treatment with alitretinoin 30 mg per day also responded to a second course of treatment. Retreatment was well tolerated. Intermittent treatment with alitretinoin is suitable for the long-term management of CHE.