tretinoin and Eczema--Dyshidrotic

Pompholyx is a chronic relapsing inflammatory vesicobullous skin disease of the hands and feet belonging to the spectrum of eczema. Established treatments, both topical and systemic, are limited in efficacy, risk:benefit ratio and prevention of further relapses. New treatment options are needed.. The article will discuss new treatment options, in particular for cheiropompholyx.. A MEDLINE and ClinicalTrials.gov research has been conducted and publications about new and emerging treatments for pompholyx have been analysed.. Among the recent developments, topical calcineurin inhibitors (TCI) and botulinum toxin A (BTXA) seem to be effective against pompholyx. The major disadvantage of BTXA is the need for injections, but efforts are being made to develop a topical form of application. Bexaroten gel has been used for chronic hand dermatitis, with good efficacy in the hyperkeratotic type. Further studies on pompholyx are needed. There is currently widespread interest in plant-based pharmaceuticals. Studies involving such topical drugs are on the way. In systemic treatment, retinoid alitretinoin has been most extensively studied in hand dermatitis. However, experiences relating to pompholyx are more limited. New types of anti-inflammatory oral drugs such as leukotriene inhibitors and phosphodiesterase-4 (PDE4) inhibitors have become available. These seem to have potential in the adjuvant treatment of pompholyx. Monoclonal antibodies of various types have been investigated in small series, but have failed to demonstrate consistent efficacy. Further investigations with new monoclonals are needed. Phototherapy of pompholyx is a cornerstone in treatment. High-dose UVA1 has been established as an effective modality in centres where the rather expensive equipment is available. Recently, UV-free phototherapy has been introduced, but more data are needed before final conclusions can be drawn.

Topics: Administration, Topical; Adolescent; Adult; Alitretinoin; Anti-Inflammatory Agents; Antibodies, Monoclonal; Botulinum Toxins, Type A; Calcineurin Inhibitors; Child; Clinical Trials as Topic; Dermatitis, Occupational; Double-Blind Method; Drug Design; Eczema, Dyshidrotic; Humans; Immunosuppressive Agents; Leukotriene Antagonists; Multicenter Studies as Topic; Phosphodiesterase Inhibitors; Photochemotherapy; PUVA Therapy; Recurrence; Tretinoin

Pompholyx remains a chronic skin affliction without a compelling pathophysiological explanation. The disease is characterized by the sudden onset of vesicles exclusively in the palms and soles which generally resolves. However, the disease may progress and the vesicles may expand and fuse; with chronicity there is deep fissuring. Multiple therapeutic approaches are available, but the disease is often resistant to conventional treatments. Currently, oral alitretinoin is used for patients with resistant chronic disease; however, this therapy is only approved for use in the UK, Europe and Canada. In this paper we wish to put forward a hypothesis: exposure to water and the subsequent steep osmotic gradient imbalance are key factors driving skin dehydration seen in pompholyx patients once the disease becomes chronic. The mechanistic explanation for the epidermal fissuring might lie in the over-expression across the mid and upper epidermis, including the stratum corneum, of two water/glycerol channel proteins aquaporin 3 and aquaporin 10, expressed in the keratinocytes of afflicted pompholyx patients. The over-expression of these two aquaporins may bridge the abundantly hydrated dermis and basal epidermis to the outer environment allowing cutaneous water and glycerol to flow outward. The beneficial effects reported in alitretinoin-treated patients with chronic hand eczemas may be due potential regulation of aquaporin 3 and aquaporin 10 by alitretinoin.

Topics: Alitretinoin; Aquaporin 3; Aquaporins; Eczema, Dyshidrotic; Glycerol; Humans; Keratinocytes; Models, Biological; Tretinoin; Water

Topics: Adult; Alitretinoin; Dermatitis, Occupational; Dermatologic Agents; Eczema, Dyshidrotic; Hand Dermatoses; Humans; Male; Tretinoin