tretinoin and Hand-Dermatoses

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.. This review summarizes the available data on the pharmacokinetics, pharmacodynamics, efficacy, and safety profile of oral alitretinoin for the treatment of CHE.. 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.

Topics: Alitretinoin; Eczema; Female; Hand Dermatoses; Humans; Quality of Life; Tretinoin

Alitretinoin is an endogenous vitamin A derivative, 9-cis-retinoic acid. Its anti-inflammatory and immunomodulatory efficacy results from controlling leukocyte activity and cytokine production in keratinocytes. We describe three patients with severe chronic hand eczema accompanied by nail dystrophy, which was treated with alitretinoin 30 mg. Clinical evaluation at 6 months showed complete or almost complete clearing of the nail lesions. We also briefly review the literature reporting on nail dystrophy and alitretinoin treatment. There is some evidence of the clinical effect of retinoids on nail formation, owing to the presence of retinoid receptors on the nail matrix. Further studies are required to better understand the impact of alitretinoin in nail diseases. Our observation supports alitretinoin as a treatment option in retinoid-responsive dermatoses associated with nail involvement.

Topics: Adult; Alitretinoin; Anti-Inflammatory Agents; Chronic Disease; Dermatologic Agents; Eczema; Female; Hand Dermatoses; Humans; Male; Middle Aged; Nail Diseases; Treatment Outcome; Tretinoin

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.

Topics: Adrenal Cortex Hormones; Alitretinoin; Calcineurin Inhibitors; Chronic Disease; Combined Modality Therapy; Dermatitis, Contact; Dermatologic Agents; Disease Management; Eczema; Emollients; Gloves, Protective; Hand Dermatoses; Humans; Immunosuppressive Agents; Occupational Diseases; Phototherapy; Practice Guidelines as Topic; Quality of Life; Tretinoin

The management of hand eczema, more readily called chronic hand dermatitis, is complex. This heaviness is related not only to the disease itself by its different clinical forms but also the multiplicity and diversity of etiological factors, triggering / maintaining or aggravating factors. The repeated therapeutic failures are ransom of incorrect information about the disease and its environment, a lack of clarity in the prescription and duration of treatment in general too short. The reference treatment is high potency topical steroids with or without occlusion for 4-8 weeks followed by alitretinoin 30 mg / day for at least 3-6 months with a monthly lipid and liver monitoring and mandatory monthly pregnancy test in women of childbearing. Associated measures and patient education are the cornerstones of successful treatment. Other alternative treatments such as phototherapy, methotrexate, cyclosporin, mycophenolate mofetil etc. can be considered in case of resistance or for clearing followed by topical treatments.

Topics: Adrenal Cortex Hormones; Algorithms; Alitretinoin; Anti-Bacterial Agents; Chronic Disease; Dermatologic Agents; Disease Management; Drug Monitoring; Drug Therapy, Combination; Eczema; Emollients; Female; Hand Dermatoses; Histamine Antagonists; Humans; Immunosuppressive Agents; Male; Patient Education as Topic; Phototherapy; Pregnancy; Pregnancy Complications; Pregnancy Tests; Salicylic Acid; Tretinoin; Tumor Necrosis Factor-alpha

Oral alitretinoin (9-cis retinoic acid) is an endogenous retinoid related to vitamin A. Studies have shown that oral alitretinoin is effective and well-tolerated in the treatment of severe chronic hand eczema, so that it is approved for this indication. This review summarizes new studies and clinical experience on the off-label use of alitretinoin.

Topics: Alitretinoin; Chronic Disease; Dermatologic Agents; Drug-Related Side Effects and Adverse Reactions; Eczema; Evidence-Based Medicine; Hand Dermatoses; Humans; Off-Label Use; Treatment Outcome; Tretinoin

Alitretinoin is an endogenous retinoid related to vitamin A. Studies have shown that oral alitretinoin is effective and well tolerated in the treatment of severe chronic hand eczema. This review summarizes the clinical pharmacokinetic and pharmacodynamic data from a number of studies involving alitretinoin. These include the effect of food on the pharmacokinetics of alitretinoin, interactions between alitretinoin and ketoconazole, simvastatin or cyclosporin A, the effect of alitretinoin on the pharmacokinetics of a combined oral contraceptive, alitretinoin in seminal fluid after repeated dosing, and the pharmacokinetics of alitretinoin and its metabolites in a clinical setting.

Topics: Administration, Oral; Alitretinoin; Animals; Chronic Disease; Dermatologic Agents; Drug Interactions; Eczema; Food-Drug Interactions; Hand Dermatoses; Humans; Tretinoin

The National Institute for Health and Clinical Excellence (NICE) invited the manufacturer of alitretinoin (Basilea Pharmaceuticals Ltd, Basel, Switzerland) to submit evidence for the clinical and cost effectiveness of this drug for the treatment of patients with severe chronic hand eczema (CHE), as part of the Institute's single technology appraisal (STA) process. The Centre for Reviews and Dissemination and the Centre for Health Economics at the University of York were commissioned to act as the Evidence Review Group (ERG). This article provides a description of the company submission, the ERG review and NICE's subsequent decisions. The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology based upon the manufacturer's submission to NICE. The ERG also independently searched for relevant evidence and modified the manufacturer's decision analytic model to examine the impact of altering some of the key assumptions. The main clinical effectiveness data were derived from a single-placebo randomized controlled trial (RCT) of daily treatment with alitretinoin for 12-24 weeks, with follow-up for a further 24 weeks, in patients with severe CHE unresponsive to topical corticosteroids. A significantly greater proportion of patients achieved 'clear' or 'almost clear' hands by week 24 with alitretinoin than those using placebo: 48% with alitretinoin 30 mg (p < 0.001); 28% with alitretinoin 10 mg (p < 0.005); 17% with placebo. Most patients who responded remained in remission during the 24-week follow-up period. The most commonly reported adverse event was dose-dependent headache, with rates of 20% in the alitretinoin 30 mg group and 11% in the alitretinoin 10 mg group, respectively. Serious adverse events were rare, although alitretinoin was associated with increases in both total cholesterol and triglycerides. No direct or indirect comparisons of alitretinoin with any of the relevant treatment comparators (psoralen + UVA [PUVA], ciclosporin or azathioprine) were available. In the manufacturer's original submission to NICE, the base-case incremental cost-effectiveness ratios (ICERs) reported for alitretinoin were pound8614 per QALY versus ciclosporin, - pound469 per QALY versus PUVA (with alitretinoin dominant) and pound10 612 per QALY versus azathioprine (year 2007-8 values). In response to a request from the ERG, the manufacturers provided a revised model that compared alitretinoin only with placebo, for which the

Topics: Alitretinoin; Dermatologic Agents; Eczema; Hand Dermatoses; Humans; Technology Assessment, Biomedical; Tretinoin

Topics: Administration, Cutaneous; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Aged; Alitretinoin; Chronic Disease; Eczema; Evidence-Based Medicine; Female; Follow-Up Studies; Hand Dermatoses; Humans; Immunosuppressive Agents; Male; Middle Aged; Randomized Controlled Trials as Topic; Retinoids; Risk Assessment; Severity of Illness Index; Treatment Outcome; Tretinoin; Young Adult

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of alitretinoin for the treatment of adults with severe chronic hand eczema refractory to topical steroid treatment in accordance with the licensed indication, based upon the evidence submission from Basilea Pharmaceuticals Ltd to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The clinical evidence came from a single placebo-controlled randomised controlled trial of daily treatment with alitretinoin for 12-24 weeks, with follow-up for a further 24 weeks, in patients with severe chronic hand eczema (CHE) unresponsive to topical steroids. A statistically significantly greater proportion of patients using alitretinoin achieved the primary end point of clear or almost clear hands by week 24 than did those with placebo. Dose-dependent headache was the most commonly reported adverse event in patients treated with alitretinoin. Serious adverse events were rare, but alitretinoin was associated with increases in both total cholesterol and triglycerides, which has implications for risks of future cardiovascular events. The manufacturer submitted a de novo decision analytic model to estimate, over a time horizon of 3 years, the cost-effectiveness of alitretinoin versus the other relevant comparators identified by NICE. In response to the points of clarification put to it by the ERG regarding the initial submission, the manufacturer provided additional evidence and a revised decision analytic model with a 'placebo' arm. In the manufacturer's original submission to NICE, the base-case incremental cost-effectiveness ratios (ICERs) reported for alitretinoin were 8614 pounds per quality-adjusted life-year (QALY) versus ciclosporin, -469 pounds per QALY versus psoralen + UVA (with alitretinoin dominant) and 10,612 pounds per QALY versus azathioprine. These ICERs decreased as the time horizon was extended in sensitivity analyses. In patients with hyperkeratotic CHE and in women of child-bearing potential, the ICER remained below 20,000. pounds When the health-related quality of life (HRQoL) values used in the model were replaced with those derived from an alternative study, these ICERs increased significantly (to 22,312 pounds per QALY for alitretinoin versus azathioprine). In the revised model, alitretinoin was reported to have an ICER of 12,931 pounds per QALY gained versus sup

Topics: Algorithms; Alitretinoin; Azathioprine; Chronic Disease; Cyclosporine; Dermatologic Agents; Eczema; Hand Dermatoses; Humans; Immunosuppressive Agents; Psychometrics; PUVA Therapy; Quality of Life; Quality-Adjusted Life Years; Tretinoin

Topics: Administration, Oral; Alitretinoin; Chronic Disease; Drug Interactions; Eczema; Hand Dermatoses; Humans; Randomized Controlled Trials as Topic; Tretinoin

After an open preliminary study, two double-blind placebo-controlled randomized studies have confirmed the value of per os alitretinoin in the management of severe chronic hand eczema (CHE). The first showed dose-dependent efficacy and a response defined as "clear" or "almost clear" by 53% of the patients receiving 10-40 mg of alitretinoin per day for 12 weeks. In the second multicenter study (the Bach study), comparing the efficacy of a 12-week alitretinoin treatment (10 mg, 30 mg) to placebo for CHE, a "clear or almost clear" result was observed in 17% (placebo group), 28% (group alitretinoin 10 mg), and 48% (group alitretinoin 30 mg). The onset of action was also significantly shorter in the group treated with 30 mg of alitretinoin compared to the group treated with 10 mg. In a study of randomized retreatment versus placebo, 80% of the patients who were initially responders to alitretinoin and whose CHE had relapsed found "clear" or "almost clear" with alitretinoin 30 mg administered for 12-24 weeks compared to 48% with alitretinoin 10 mg. In all the studies, clinical tolerance was comparable and satisfactory, with the most frequent negative side effects being headache, flushing, and mucocutaneous signs identical to those compared with other retinoids. An increase in cholesterol and/or triglycerides was the most frequent biological side effect. Central hypothyroidism, with no clinical expression, was observed more rarely. These studies confirm that alitretinoin treatment can be envisaged as second-line therapy in adults with CHE that does not respond to well-observed treatment with class potent or very potent dermocorticoids.

Topics: Adult; Alitretinoin; Antineoplastic Agents; Chronic Disease; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Eczema; Hand Dermatoses; Humans; Multicenter Studies as Topic; Randomized Controlled Trials as Topic; Tretinoin

Topics: Administration, Oral; Alitretinoin; Chronic Disease; Clinical Trials as Topic; Dermatologic Agents; Eczema; Glucocorticoids; Hand Dermatoses; Humans; Ointments; Phototherapy; Physical Therapy Modalities; PUVA Therapy; Time Factors; Tretinoin

About 10% of Germans have chronic hand eczema (CHE). Until recently only off-label use agents existed for the treatment of severe CHE cases refractory to topical steroids. In addition, data from controlled clinical trials confirming the efficacy of known treatment strategies was inadequate. With the availability of alitretinoin, 9-cis retinoic acid, this situation may change. In two large clinical trials alitretinoin showed high response rates and a favorable safety profile in the treatment of severe and refractory CHE. Alitretinoin has an anti-inflammatory and immunomodulatory mechanism of action. Acting as a panagonist it binds to retinoic acid receptors A (RAR) and X (RXR). It directly affects cytokine production in keratinocytes and down-regulates leukocyte activity. When used for CHE with detailed patient counseling and appropriate laboratory monitoring, alitretinoin is a promising new option for systemic treatment.

Topics: Alitretinoin; Anti-Infective Agents; Chronic Disease; Clinical Trials as Topic; Dermatologic Agents; Eczema; Hand Dermatoses; Humans; Recurrence; Treatment Outcome; Tretinoin

Alitretinoin (9-cis-retinoic acid) is a unique panagonist retinoid, capable of binding to all six known retinoid receptors (RAR-alpha, -beta, -gamma, and RXR-alpha, -beta, -gamma). Studies are being carried out to determine how best to utilize this characteristic in treatments for conditions such as chronic hand dermatitis.. To review the literature on alitretinoin.. The scope of the review encompasses ways that alitretinoin is currently and may potentially be utilized.. Orally administered alitretinoin is a safe and effective treatment for chronic hand dermatitis. Topical treatment with alitretinoin can be expanded into other areas such as photoaged skin and cutaneous T-cell lymphoma. Despite these benefits, oral alitretinoin will face a difficult path attaining approval for use in the US.

Topics: Administration, Oral; Alitretinoin; Antineoplastic Agents; Hand Dermatoses; Humans; Receptors, Retinoic Acid; Sarcoma, Kaposi; Tretinoin

Palmoplantar pustulosis (PPP) is an inflammatory, debilitating skin disease. Topical drugs and systemic immunosuppressive agents are often ineffective. Previous uncontrolled studies have suggested that alitretinoin could be a meaningful treatment option for PPP.. The primary objective was to determine response to alitretinoin for the treatment of PPP based on the Palmoplantar Pustulosis Area and Severity Index (PPPASI) after 24 weeks of treatment.. A phase II, randomized, double-blind, placebo-controlled, multicentre study. Adult patients with PPP (with or without psoriasis) refractory to topical therapy and standard skin care were randomized 2:1 to alitretinoin 30 mg once daily or placebo for up to 24 weeks. The primary end point was PPPASI at week 24 (or the last visit in case of early withdrawal). Secondary end points included: percentage change from baseline in the modified Psoriasis Area and Severity Index (mPASI); percentage of patients with ≥ 50% or 75% improvement in PPPASI or mPASI scores from baseline; change in pustule count on the palms and soles; change in the Nail Psoriasis Severity Index and safety and tolerability assessments.. Thirty-three patients were randomized: 24 patients to alitretinoin 30 mg and nine to placebo. Overall, there were no significant differences between alitretinoin 30 mg and placebo for any end point. The safety profile was consistent with that seen in patients with chronic severe hand eczema refractory to potent topical corticosteroids.. Although the results were unexpected based on previous studies of alitretinoin in the treatment of PPP, this study provided no evidence to support further exploration of alitretinoin in the treatment of severe PPP.

Topics: Administration, Cutaneous; Administration, Oral; Alitretinoin; Dermatologic Agents; Double-Blind Method; Drug Administration Schedule; Female; Foot Dermatoses; Hand Dermatoses; Humans; Male; Middle Aged; Psoriasis; Severity of Illness Index; Treatment Outcome; Tretinoin

Quality-switched (QS) laser therapy is a safe and well-established treatment option for removing solar lentigines. Triple combination therapy (TCT) with the active pharmaceutical ingredients hydroquinone 5%, tretinoin 0.03%, and dexamethasone 0.03% is often used for skin-lightening.. This prospective, open-label trial compares the efficacy and safety of a QS Ruby laser (QSRL) and a TCT in the treatment of solar lentigines.. In total, 15 patients with symmetrically distributed solar lentigines on the back of both hands were included. The lesions on the back of the right hand were treated in one or 2 sessions with a QSRL, the ones on the back of the left hand with a TCT for 7 weeks accompanied by UV protection. Clinical results were evaluated 4 weeks, 8 weeks, and 20 weeks after baseline.. Treatment with QSRL provided significant lightening (p = .01) compared with TCT. Both procedures were generally well-tolerated. Comparing the side effects, the laser produced significantly more crusting and hyperpigmentation than the TCT.. Both QSRL and TCT were capable in reducing solar lentigines in Fitzpatrick skin Type I to IV with an acceptable side effect profile. The QSRL provides faster, superior, and long lasting lightening compared with TCT.

Topics: Aged; Dexamethasone; Drug Combinations; Erythema; Female; Hand Dermatoses; Humans; Hydroquinones; Lasers, Solid-State; Lentigo; Male; Middle Aged; Pain; Prospective Studies; Skin Cream; Skin Lightening Preparations; Tretinoin

Post-inflammatory hyperpigmentation is a frequent concern when treating solar lentigines.. To assess the safety and efficacy of a triple combination cream with fluocinolone acetonide 0.01%, hydroquinone 4% and tretinoin 0.05% as adjuvant to cryotherapy in the treatment of solar lentigines in hands dorsum, and in the prevention of post-inflammatory hyperpigmentation after cryotherapy.. This prospective, randomized, controlled, investigator-blinded, single-centre study enrolled 50 patients. Twenty-five patients received a 2-week daily triple combination cream plus sunscreen pre-treatment and 25 received sunscreen alone. After that, cryotherapy was performed in all patients followed by a 3-week recovery period. After this period, patients received the same initial treatment and were followed up for 8 weeks. Melanin and erythema levels of a target and a control lentigo were objectively measured using a narrowband reflectance spectrophotometer. Lentigines count, colour homogeneity and global improvement were also assessed.. The number of solar lentigines reduced in the first 2 weeks only in patients who used the triple combination 25 ± 7 vs. 22 ± 8 (P < 0.0001), and reduced at the end of the study for both groups (P < 0.0001). The melanin levels also reduced in the first 2 weeks only in patients who used the triple combination 297 ± 69 vs. 273 ± 66 (P < 0.0001) and reduced at the end of the study for both groups (P < 0.0001). Erythema and residual blisters from cryotherapy were the reported adverse reactions.. Triple combination cream can be used to enhance the resolution of solar lentigines, and to significantly reduce melanin levels and lentigines count, improving treatment results. It was well-tolerated and did not increase the occurrence of neither erythema nor other side-effects after the cryotherapy.

Topics: Anti-Inflammatory Agents; Antineoplastic Agents; Antioxidants; Chemotherapy, Adjuvant; Cryotherapy; Drug Combinations; Erythema; Female; Fluocinolone Acetonide; Hand Dermatoses; Humans; Hydroquinones; Lentigo; Male; Melanins; Middle Aged; Prospective Studies; Single-Blind Method; Skin Cream; Sunlight; Tretinoin

Alitretinoin (9-cis-retinoic acid, Toctino(®) ) has been marketed recently for oral therapy for chronic hyperkeratotic hand eczema. As alitretinoin is highly lipophilic and metabolized mainly in the liver, it is currently considered to be contraindicated in patients with liver disease. However, the pharmacokinetics and metabolism of alitretinoin have not been studied in these patients.. To study the single-dose pharmacokinetics and metabolism of alitretinoin and its metabolites in patients with cirrhosis following oral administration.. Eight patients with cirrhosis and eight matched volunteer healthy controls were given a single 30-mg oral dose of alitretinoin. Blood and urine samples were collected during the following 24-h study period. Samples were analysed for alitretinoin and for known metabolites using reverse-phase high-performance liquid chromatography. The pharmacokinetics were then evaluated using standard noncompartmental models.. No significant differences were found between healthy controls and patients with cirrhosis when analysing the pharmacokinetic parameters of alitretinoin and its metabolites. Thus, the mean half-lives of alitretinoin were 5·3 and 5·6 h (P = 0.733) and the oral clearances were 1·92 and 1·39 L h(-1) kg(-1) (P = 0·243) in the patient group and the healthy control group, respectively.. The metabolism and pharmacokinetics of alitretinoin following oral administration of the recommended dose of 30 mg for the treatment of severe hand eczema were similar in patients with cirrhosis and in healthy controls. If indicated, alitretinoin can be used in these patients with careful and close monitoring.

Topics: Administration, Oral; Aged; Alitretinoin; Area Under Curve; Dermatologic Agents; Eczema; Female; Hand Dermatoses; Humans; Liver Cirrhosis; Male; Middle Aged; Tretinoin

We examined and evaluated the clinical characteristics of patients who had come to the Allergological and Occupational Dermatology unit in Florence with severe CHE refractory to potent topical corticosteroids. We evaluated the efficacy and safety of alitretinoin and we analyzed the response in the three months of follow-up in the group of patients who completed the cycle of therapy. Improvement in clinical signs and symptoms was assessed using mTLSS and PGA.. All patients were treated daily with single 30-mg doses of oral alitretinoin for 3 to 5 months. The study examined 15 patients with a clinical diagnosis of severe CHE. We found the treatment to be efficient in nine of 13 patients (69%) who were assessed as having "clear" or "almost clear" hands according to PGA.. Even if the number of patients we analyzed was limited and lacked a control group the study allowed us to confirm the efficacy of alitretinoin used in a "real life" clinical experience. In addition, thanks to the adoption of proper emollient therapy and avoidance of any relevant allergens or irritants, no recurrence of the condition was observed among the patients who completed therapy with a PGA value of "mild", "almost clear", or "clear" during three months after treatment.

Topics: Administration, Cutaneous; Administration, Oral; Adolescent; Adult; Alitretinoin; Chronic Disease; Dermatologic Agents; Dose-Response Relationship, Drug; Eczema; Emollients; Female; Follow-Up Studies; Hand Dermatoses; Humans; Male; Middle Aged; Risk Assessment; Severity of Illness Index; Treatment Outcome; Tretinoin

Severe chronic hand eczema (sCHE) is a persistent, disfiguring disease that responds poorly to conventional treatment and causes substantial physical and psychological disability. The objective of this study was to evaluate efficacy and safety of oral alitretinoin in sCHE in a Phase 3, multicenter, randomized, double-blind, placebo-controlled, parallel-group study comparing alitretinoin with placebo. Efficacy was assessed every 4 weeks during treatment and 4 weeks after end of treatment (EOT, 24 weeks); responders were assessed every 4 weeks for a further 48 weeks after EOT. The study was conducted at academic and private dermatology centers. The participants were 596 patients with sCHE refractory to potent topical corticosteroids. Patients were treated with daily oral alitretinoin 30 mg or placebo for up to 24 weeks. Primary endpoint was proportion of responding patients based on Physician Global Assessment (PGA) of "clear" or "almost clear" at EOT. Key secondary endpoints: Patient Global Assessment (PaGA), change in modified Total Lesion Symptom Score (mTLSS), time to response (TTR), extent of disease at EOT, and duration of response (DOR). At EOT, 40% of alitretinoin-treated patients were responders vs 15% placebo-treated patients (odds ratio [OR] = 3.78; P < .001); a greater proportion of alitretinoin-treated patients achieved a PaGA of "cleared" or "almost cleared" (OR = 4.05; P< .001). A greater decrease in mTLSS occurred from baseline to EOT in alitretinoin- vs placebo-treated patients (treatment difference -24% P< .001). Median TTR for responders at EOT was shorter with alitretinoin vs placebo (65 vs 117 days; P< .001). Greater decreases in extent of disease at EOT were observed with alitretinoin vs placebo (treatment difference -22%; P< .001). The most common treatment-emergent adverse event was headache. Alitretinoin significantly improved signs/symptoms of sCHE, was well tolerated in patients refractory to potent topical corticosteroids, and may provide benefit to this population.

Topics: Administration, Oral; Adrenal Cortex Hormones; Adult; Alitretinoin; Chronic Disease; Dermatologic Agents; Double-Blind Method; Eczema; Female; Follow-Up Studies; Hand Dermatoses; Humans; Male; Middle Aged; Severity of Illness Index; Treatment Outcome; Tretinoin

Blinded, controlled studies have found that oral alitretinoin is well tolerated and effective in the treatment of severe chronic hand eczema (CHE).. To assess the safety and efficacy of oral alitretinoin in patients with severe CHE in an open-label study using flexible dosing and a new measurement of patient-relevant benefits.. In total, 249 patients aged 18-75 years with severe CHE unresponsive to treatment with topical corticosteroids received alitretinoin 30 mg once daily for up to 24 weeks. Safety assessments included adverse events (AEs) and laboratory tests. Efficacy assessments included Physician's Global Assessment (PGA), the Modified Total Lesion Symptom Score, Patient's Global Assessment and extent of disease, as well as intensity of pain and pruritus as determined by visual analogue scale (VAS) and a categorical scale for pruritus.. Alitretinoin was well tolerated when given for up to 24 weeks. Dose reduction occurred in 16.5% of patients. Dose interruption was required for 15.7% of patients, most commonly for headache. AEs and laboratory changes comprised effects typical of the retinoid class. A PGA response of 'clear' or 'almost clear' hands was reported for 46.6% of patients, similar to the response rate seen in blinded trials. Results of VAS and categorical assessments of pruritus provided supporting evidence of efficacy, and treatment was assessed as providing meaningful benefits to patients.. Oral alitretinoin 30 mg was well tolerated and effective, and provided distinct therapeutic benefits in severe CHE, as assessed by patients.

Topics: Administration, Oral; Adolescent; Adult; Aged; Alitretinoin; Chronic Disease; Dermatologic Agents; Drug Administration Schedule; Female; Glucocorticoids; Hand Dermatoses; Humans; Male; Middle Aged; Severity of Illness Index; Treatment Failure; Treatment Outcome; Tretinoin; Young Adult

Alitretinoin (9-cis-retinoic acid) is an endogenous derivative of vitamin A and functions as an agonist of both families of nuclear receptors (retinoic acid receptor-α, -β, -γ; retinoid X receptor-α, -β, -γ). It has been investigated in the treatment of chronic hand eczema in many studies in recent years and the results have been promising.. To evaluate the efficacy and safety of oral alitretinoin in the treatment of chronic hand eczema that is refractory to treatment with potent topical corticosteroids and to analyze the long-term response to treatment.. A prospective, observational, descriptive study was undertaken in 15 patients with chronic hand eczema that was refractory to treatment with potent topical corticosteroids. Patients were administered oral alitretinoin 30 mg/d for 3 months followed by 6 months of follow-up.. A complete response, with "clear" hands was obtained in 7 patients (47%), 5 patients (33%) achieved a partial response (almost clear hands), 1 patient (7%) showed substantial improvement, 1 (7%) showed moderate improvement, and 1 patient (7%) did not respond to treatment. Relapse occurred within 6 months of treatment suspension in 54% of cases. The treatment was well tolerated. Side effects, observed in 50% of cases, were mild (headache, elevated lipid levels, slightly elevated transaminase levels, and epigastric pain), except in 1 patient, who had a substantial reduction in thyroid stimulating hormone levels.. The results of our study support the proposal of alitretinoin as an effective and safe short-term and medium-term treatment for chronic hand eczema in patients whose disease is refractory to treatment with potent topical corticosteroids.

Topics: Administration, Cutaneous; Administration, Oral; Adrenal Cortex Hormones; Adult; Aged; Alitretinoin; Child; Chronic Disease; Drug Resistance; Eczema; Female; Hand Dermatoses; Headache; Humans; Hypercholesterolemia; Middle Aged; Occupational Diseases; Prospective Studies; Thyrotropin; Treatment Outcome; Tretinoin

Recent studies have found that alitretinoin can induce clinically significant responses in subjects with severe chronic hand eczema (CHE) unresponsive to topical corticosteroids.. To assess the pharmacokinetics (PK), efficacy and safety of alitretinoin 10 or 30 mg once daily.. This was a randomized, double-blind study, which enrolled 32 subjects aged 18-75 years with CHE unresponsive to potent topical corticosteroids. Subjects received alitretinoin 10 mg (n = 16) or 30 mg (n = 16) once daily for 12 or 24 weeks. Standard PK variables [area under the curve (AUC) of plasma concentration vs. time, maximum plasma concentration (C(max)), time to maximum plasma concentration (t(max)), elimination half-life (t(1/2)), total systemic clearance (CL/F) and volume of distribution (Vd/F)] were determined for alitretinoin and metabolites. Efficacy was assessed using the Physician's Global Assessment (PGA) scale.. Chronic administration of alitretinoin for up to 24 weeks did not result in accumulation or time-dependent changes in the disposition of alitretinoin. Exposure was found to be proportional to dose. Systemic exposure (AUC) to alitretinoin was proportional to dose for 10 and 30 mg alitretinoin; 62.8% of subjects achieved clear/almost clear hands in the 30 mg group and 12.5% in the 10 mg group. Alitretinoin was well tolerated.. Chronic administration of alitretinoin for 12-24 weeks did not lead to accumulation or time-dependent changes in drug exposure. Alitretinoin was effective and well tolerated in the treatment of subjects with moderate or severe CHE unresponsive to potent topical corticosteroids.

Topics: Adolescent; Adult; Aged; Alitretinoin; Chronic Disease; Dermatologic Agents; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Hand Dermatoses; Humans; Male; Middle Aged; Treatment Outcome; Tretinoin; Young Adult

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.. 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.. 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.. 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.. 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.

Topics: Administration, Oral; Alitretinoin; Chronic Disease; Dermatologic Agents; Double-Blind Method; Eczema; Female; Hand Dermatoses; Humans; Male; Middle Aged; Recurrence; Retreatment; Time Factors; Treatment Outcome; Tretinoin

Solar lentigines represent a common feature of photoaging, particularly on the back of the hands. Bleaching agents are usually proposed to lighten the shade of the lesions.. The study was randomized and designed to assess the effect of a bleaching solution containing 2% mequinol (4-hydroxyanisole, 4HA) and 0.01% tretinoin (Solagé). The formulation was applied twice daily for 3 months on solar lentigines present on the back of one hand. The lesions on the other hand were treated with the ethyl alcohol vehicle which served as a control. Clinical diagnosis was confirmed using dermoscopy. In addition, objective measurements of the hypermelanosis were performed at 1-month intervals during and after treatment. Clinical assessments were used as well as narrow-band reflectance spectrophotometry, image analysis of video-recorded ultraviolet light-enhanced visualization (ULEV method) and photodensitometry of the corneomelametry test.. The multipronged assessment of the lesional color demonstrated a significant lightening effect of the 4HA/tretinoin solution. This was demonstrated after 2 months of treatment and was maintained at least 2 months after stopping treatment.. Both the visual ratings and the objective bioinstrumental methods indicate the rapid lightening effect of the 4HA/tretinoin formulation. After stopping treatment, the rate of repigmentation appeared to have slowed compared to the depigmentation phase.

Topics: Absorptiometry, Photon; Administration, Cutaneous; Aged; Anisoles; Antioxidants; Dermoscopy; Drug Therapy, Combination; Female; Follow-Up Studies; Hand Dermatoses; Humans; Keratolytic Agents; Lentigo; Middle Aged; Skin Aging; Spectrophotometry; Sunlight; Tretinoin; Ultraviolet Rays; Video Recording

Patients with severe chronic hand eczema (CHE) refractory to topical corticosteroids currently have limited treatment options suited for chronic use, and few controlled clinical studies have investigated new therapies in this setting.. To assess the efficacy and safety of oral alitretinoin (9-cis retinoic acid) taken at 10 mg or 30 mg once daily for up to 24 weeks, compared with placebo control, in the treatment of severe CHE refractory to topical corticosteroids.. A randomized, double-blind, placebo-controlled, prospective, multicentre trial was conducted in 111 dermatology outpatient clinics in Europe and Canada. A total of 1032 patients with severe refractory CHE were randomized in a 1 : 2 : 2 ratio to placebo, or 10 mg or 30 mg of oral alitretinoin once daily for up to 24 weeks. Safety was assessed for all patients during a follow-up period of 4 weeks, and responders were observed for relapse for 24 weeks after the end of therapy. The primary efficacy parameter was Physician Global Assessment of overall CHE severity, with response defined as clear or almost clear hands.. Responses, defined as clear or almost clear hands, were achieved in up to 48% of patients treated with alitretinoin, compared with 17% for placebo (P < 0.001), with up to 75% median reduction in disease signs and symptoms. Treatment was well tolerated, with dose-dependent adverse effects comprising headache, mucocutaneous events, hyperlipidaemia, and decreased free thyroxine and thyroid-stimulating hormone. The median time to relapse, defined as recurrence of 75% of initial signs and symptoms, was 5.5-6.2 months in the absence of anti-eczema medication.. Alitretinoin given at well-tolerated doses induced clearing of CHE in a substantial proportion of patients with severe disease refractory to standard therapy.

Topics: Adolescent; Adult; Aged; Alitretinoin; Chronic Disease; Dermatologic Agents; Dose-Response Relationship, Drug; Drug Administration Routes; Eczema; Epidemiologic Methods; Female; Hand Dermatoses; Humans; Male; Middle Aged; Tretinoin

To assess the efficacy and safety of oral alitretinoin (9-cis-retinoic acid), 10 mg/d, 20 mg/d, and 40 mg/d, compared with placebo control, in the treatment of chronic hand dermatitis.. Multicenter, randomized, double-blind, placebo-control, prospective trial.. A total of 43 outpatient clinics in 10 European countries.. Of 348 patients screened, 319 with moderate or severe refractory chronic hand dermatitis were randomized, in the ratio of 1:1:1:1, to 4 treatment groups and received allocated intervention. Of 75 patients who withdrew, 24 withdrew owing to adverse events.. Placebo or 10 mg, 20 mg, or 40 mg of oral alitretinoin (9-cis-retinoic acid) taken once daily for 12 weeks. Safety was assessed for all patients during a follow-up period of 4 weeks, and responders were observed for a follow-up period of 3 months.. Physician's global assessment of overall chronic hand dermatitis severity.. Alitretinoin led to a significant and dose-dependent improvement in disease status, with responses in up to 53% of patients, and up to a 70% mean reduction in disease signs and symptoms. Treatment was generally well tolerated, with dose-dependent effects comprising headache, flushing, mucocutaneous events, hyperlipidemia, and decreased hemoglobin and decreased free thyroxin levels. Three months after discontinuation of treatment, the rate of relapse was 26%, independent of dose.. Alitretinoin given at well-tolerated doses induced substantial clearing of chronic hand dermatitis in patients refractory to conventional therapy.

Topics: Administration, Oral; Adrenal Cortex Hormones; Alitretinoin; Chronic Disease; Dose-Response Relationship, Drug; Double-Blind Method; Drug Resistance; Female; Follow-Up Studies; Hand Dermatoses; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Treatment Outcome; Tretinoin

Solar lentigines are a chronic condition of the aging population resulting from years of cumulative sun exposure. A topical treatment that is both safe and effective would be welcome and useful. Combinations of therapeutic agents are often used and allow synergy of mechanisms with tolerability. A tyrosinase inhibitor in use in Europe, 4-hydroxyanisole (Mequinol), and the retinoid tretinoin have been used singly as depigmenting agents.. The efficacy and safety of the combination product of 2% 4-hydroxyanisole (4HA [mequinol]) /0.01% tretinoin solution (tradename Solagé) were evaluated in two phase III, randomized, controlled, double-blind trials.. Subjects were randomized to treatment with 4HA/tretinoin solution, one of the active components (4HA or tretinoin), or vehicle. Subjects applied the test solution with a wand applicator twice daily to all solar lentigines and related hyperpigmented lesions on the face, forearms, and backs of hands for up to 24 weeks. Trial 1 had a 24-week no-treatment regression phase and trial 2 had a 4-week no-treatment regression phase. Information collected included clinical assessments of Target Lesion Pigmentation, Physician's Global Assessment of Improvement/Worsening, an Assessment of Overall Cosmetic Effect, and a Subject's Self-Assessment Questionnaire.. The 4HA/tretinoin combination was clinically superior to each of its active components and to the vehicle in the treatment of solar lentigines. At the end of treatment, in trial 1 and trial 2, 4HA/tretinoin was statistically superior to each of its active components and vehicle on the forearms and face (P

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Anisoles; Antioxidants; Arm; Double-Blind Method; Drug Therapy, Combination; Facial Dermatoses; Female; Hand Dermatoses; Humans; Hyperpigmentation; Keratolytic Agents; Lentigo; Male; Middle Aged; Severity of Illness Index; Treatment Outcome; Tretinoin

9-cis-Retinoic acid (9-cis-RA) has a particular pattern of binding and activating retinoid receptors. Treatment of chronic hand eczema is often refractory to conventional treatment.. Evaluation of oral 9-cis-RA therapy in chronic hand eczema in a pilot study.. Thirty-eight patients with refractory chronic hand eczema were treated in an exploratory open-label study with oral 9-cis-RA.. Twenty-one (55%) showed a very good response, 13 (34%) a good response, 2 (5.5%) a moderate response and 2 (5.5%) no response. Side effects were mild.. 9-cis-RA is a valuable drug when given at low doses to patients with chronic hand eczema.

Topics: Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Alitretinoin; Antineoplastic Agents; Cheilitis; Chronic Disease; Eczema; Female; Flushing; Hand Dermatoses; Headache; Humans; Male; Middle Aged; Patient Satisfaction; Pilot Projects; Severity of Illness Index; Skin; Treatment Outcome; Tretinoin

A multicentre clinical trial has been conducted to assess the efficacy and safety of tretinoin 0.05% cream (Retin-A) in the treatment of photo-damaged Australian skin. Subjects with cutaneous facial photodamage were randomised to treatment with tretinoin (62) or vehicle (63) cream. After an initial two week run-in, all subjects applied the cream to the face, neck and left forearm/hand, once nightly for 24 weeks. Changes in clinical signs of photodamage and parameters of cutaneous irritation were assessed by investigators using a 7 point scale, whilst changes in signs of photodamage were rated by subjects using a 5 point scale. Changes in skin biopsies and silicone skin surface replicas were also assessed. Significant improvements in skin wrinkles, mottled hyperpigmentation, laxity, lentigines and roughness of tretinoin treated subjects were noted by investigators. Subjects receiving tretinoin noted significant improvements in skin wrinkles, tightness, colour and pores. Improvement in overall severity of photodamage was significantly greater for tretinoin treated subjects and was progressive over the study period. Histological findings included a significant increase in mean epidermal thickness. Significant topographical changes were not detected in skin surface replica sets. Cutaneous irritation, the most common side effect, was usually mild and transient. We conclude that tretinoin 0.05% cream significantly improved the appearance of photo-damaged skin.

Topics: Administration, Cutaneous; Adult; Aged; Australia; Double-Blind Method; Facial Dermatoses; Female; Hand Dermatoses; Humans; Male; Middle Aged; Photosensitivity Disorders; Prospective Studies; Treatment Outcome; Tretinoin

Hyperpigmented lesions are a predominant component of photoaging in Chinese and Japanese persons. Topical 0.1% tretinoin cream improves the hyperpigmentation associated with photoaging in Caucasian persons.. Our purpose was to assess the efficacy of 0.1% tretinoin cream treatment of hyperpigmented lesions associated with photoaging in Chinese and Japanese patients.. Forty-five photoaged patients (23 Chinese, 22 Japanese) completed a double-blind, randomized study in which 21 applied 0.1% tretinoin cream and 24 applied vehicle cream once daily to face and/or hands for 40 weeks. Patients' hyperpigmented lesions were evaluated clinically and by colorimetry throughout the study and by histologic analysis of skin biopsy specimens taken before therapy and at the end of treatment.. At the end of treatment, hyperpigmented lesions of the face and hands were lighter or much lighter in 90% of patients receiving tretinoin compared with 33% receiving vehicle (p < 0.0001). Colorimetry demonstrated significant lightening of lesions after tretinoin compared with vehicle (p < 0.05). Histologic analysis of hyperpigmented lesions demonstrated a statistically significant 41% decrease in epidermal pigmentation with tretinoin therapy as compared with a 37% increase in the vehicle group (p = 0.0004). No patient withdrew for adverse effects.. By clinical, colorimetric, and histologic evaluation, 0.1% tretinoin cream significantly lightens the hyperpigmentation of photoaging in Chinese and Japanese patients.

Topics: Administration, Topical; Adult; Aged; Asian; Biopsy; China; Double-Blind Method; Facial Dermatoses; Female; Hand Dermatoses; Humans; Hyperpigmentation; Japan; Male; Middle Aged; Photography; Skin Aging; Treatment Outcome; Tretinoin

We conducted a double-blind, placebo-controlled, prospective, randomized study to assess the effects of tretinoin pretreatment on healing after trichloroacetic acid (TCA) chemical peel. Sixteen male patients (mean age, 67 years) with actinically damaged skin were treated daily with 0.1% tretinoin and placebo creams to the left and right halves of the face and the left and right forearms and hands, respectively, for 14 days prior to the 35% TCA peel. We subjectively noted that during the peel, "frosting" was more pronounced and uniform and occurred earlier in tretinoin-pretreated skin in 94% of the patients. Healed skin was measured planimetrically, and the healed area was determined with point stereology. Regardless of pretreatment, the face healed twice as fast as the forearm or hand. In all regions, the mean area healed was significantly greater in skin that had been pretreated with tretinoin. The differences between tretinoin and placebo, respectively, in healed skin were maximal after 5 days for the face (68% vs 52%), after 11 days for the forearms (72% vs 24%), and after 9 days for the hands (61% vs 29%). After 7 days, 75% of the tretinoin-pretreated hemifaces were completely healed, as opposed to 31% of the placebo-pretreated hemifaces. By visual inspection, we could not appreciate a cosmetic difference between tretinoin- and placebo-pretreated skin 2 weeks and 3 months after the TCA peel. We conclude that 0.1% tretinoin pretreatment for 2 weeks prior to the TCA peel will significantly speed healing, which may result in greater patient satisfaction. Patients presently being treated with tretinoin who later undergo a TCA peel might be expected to have similar results.

Topics: Aged; Aged, 80 and over; Chemexfoliation; Double-Blind Method; Facial Dermatoses; Forearm; Hand Dermatoses; Humans; Keratosis; Male; Middle Aged; Placebos; Premedication; Prospective Studies; Skin; Tretinoin; Trichloroacetic Acid; Wound Healing

Six patients with persistent palmoplantar pustulosis were treated with acitretin, and the clinical response was compared with the effect on the intra-epidermal accumulation of polymorphonuclear PMN leukocytes. A prompt improvement of pustule formation and subsequently decreased scaling and erythema was seen in all patients. Following discontinuation of therapy, a relapse occurred within 2 weeks. With dosages of 45 or 55 mg/day, the clinical scores were only slightly better than with 25 or 35 mg/day. In patients using 25 mg acitretin a day, the leukotriene B4-induced intra-epidermal accumulation of polymorphonuclear leukocytes was not affected. However, a dosage of 35 mg/day resulted in a significant inhibition of PMN accumulation, dosages of 45 and 55 mg/day causing an even more pronounced inhibition of this process. Although the effect of different dosages of acitretin is not clearly expressed in the severity scores, the dose-dependent effect on PMN chemotaxis in vivo might be of relevance when combination therapies are considered, in order to achieve a complete clinical clearance.

Topics: Acitretin; Adult; Chemotaxis, Leukocyte; Clinical Trials as Topic; Drug Tolerance; Female; Foot Dermatoses; Hand Dermatoses; Humans; Male; Middle Aged; Neutrophils; Psoriasis; Skin Diseases, Vesiculobullous; Tretinoin

Sixty patients with palmoplantar pustulosis were treated in a double-blind trial with either acitretin (etretin, Ro 10-1670) or with etretinate. The study consisted of 4 weeks of therapy with three 10 mg capsules/day followed by 8 weeks of therapy with a varying number of capsules given daily according to therapeutic response. At the end of the 12-week treatment period, the mean number of pustules (+/- SEM) had decreased from 57.8 (+/- 8.6) to 3.9 (+/- 1.6) in the acitretin group and from 57.1 (+/- 14.1) to 5.7 (+/- 2.7) in the etretinate group. With regard to influence on erythema, infiltration, scaling, and area involved, similar improvements were obtained in both treatment groups. Adverse reactions of the hypervitaminosis A type were observed with almost the same frequency and severity in both treatment groups. The mean number of 10 mg capsules used daily was comparable in the two groups: 2.82 (range 1.23-4.67) for acitretin and 2.77 (range 1.60-4.82) for etretinate. It can be concluded that acitretin and etretinate do not significantly differ with regard to efficacy and overall safety in the treatment of patients with palmoplantar pustulosis.

Topics: Acitretin; Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Etretinate; Female; Foot Dermatoses; Hand Dermatoses; Humans; Male; Middle Aged; Random Allocation; Tretinoin

In a double-blind, cross-over trial with Tigason and placebo, the parameters of palmoplantar pustulosis underwent significant changes during the retinoid therapy. A hand-over effect was clearly indicated during the placebo period and several patients experienced long-lasting remissions.

Topics: Adult; Aged; Clinical Trials as Topic; Dermatologic Agents; Double-Blind Method; Etretinate; Female; Foot Dermatoses; Hand Dermatoses; Humans; Middle Aged; PUVA Therapy; Scalp Dermatoses; Suppuration; Tretinoin

Nineteen patients with chronic, recalcitrant palmoplantar pustulosis took either placebo or aromatic retinoid ethyl ester (Ro 10-9359) during a 4-month therapeutic trial. The maximal dose of Ro 10-9359 varied between 25 and 100 mg per day, according to the individual patient's tolerance. An excellent or good therapeutic response was obtained in 6 out of 9 patients on the active medication and in 2 out of 10 patients on placebo. The difference in therapeutic response between the Ro 10-9359 group and the placebo group was statistically significant (p less than 0.05). Drying and chapping of the lips was the most common side effect of Ro 10-9359 treatment.

Topics: Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Drug Evaluation; Female; Foot Dermatoses; Hand Dermatoses; Humans; Male; Middle Aged; Placebos; Tretinoin; Vitamin A

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.

Topics: Adult; Alitretinoin; Chronic Disease; Dermatologic Agents; Dermatology; Eczema; Female; Hand Dermatoses; Humans; Italy; Male; Middle Aged; Retrospective Studies; Treatment Outcome; Tretinoin

Alitretinoin is a systemic retinoid licensed for use in adult patients suffering from chronic hand eczema recalcitrant to potent topical steroids. Experience with its use in childhood is lacking.. To report on the efficacy and safety of alitretinoin treatment in a cohort of children and adolescents with chronic hand eczema (CHE) and other inflammatory skin diseases.. We performed a retrospective chart review of all consecutive patients under the age of 18 years treated with alitretinoin at our paediatric skin centre. Physician's Global Assessment (PGA) was used as the primary outcome measure.. Thirteen children (9 girls and 4 boys) were enrolled in this study. The median age at start of treatment with alitretinoin was 11.5 years (range 5.8-15.8 years). Nine children were diagnosed with CHE, two with severe atopic dermatitis (AD), and two with inherited ichthyosis [netherton syndrome (NS), autosomal recessive congenital ichthyosis (ARCI)]. Moderate to excellent response (PGA decrease of ≥1 point) was observed in 7 (78%) of the nine patients with CHE, one of the two patients with extensive AD and in the one patient with ARCI. In the remaining four subjects, no convincing effect was documented. Tolerability was overall very good. The most common adverse event was headache in 10 patients (77%) during the initiation of treatment, leading to interruption of therapy in one subject.. Alitretinoin seems to be highly effective and safe for the treatment of paediatric CHE and should thus be considered in children with refractory disease under topical therapy. Larger studies are required to corroborate these findings.

Topics: Adolescent; Adult; Alitretinoin; Child; Child, Preschool; Chronic Disease; Dermatologic Agents; Eczema; Female; Hand Dermatoses; Humans; Male; Retrospective Studies; Treatment Outcome; Tretinoin

Treatment of severe hand eczema (HE) that is resistant to topical potent corticosteroid treatment is challenging. In 2013, we surveyed 194 UK dermatologists to obtain information about their usual treatment pathways to inform the choice of the comparator in a trial of alitretinoin in severe HE (ALPHA trial); the results indicated that the treatment approaches favoured by UK dermatologists differ. Psoralen combined with ultraviolet A (PUVA) and alitretinoin were identified as the most frequent first-line treatment options for hyperkeratotic HE, whereas oral corticosteroids were identified as the most frequent first-line treatment for vesicular HE, followed by PUVA and alitretinoin. In terms of potential adverse effects of long-term or repeated use, oral steroids and ciclosporin A were reported to cause most concern. There is uncertainty about which treatment gives the best short and long-term outcomes, because of a lack of definitive randomised controlled trials evaluating the effectiveness of different treatment pathways in severe HE.

Topics: Administration, Oral; Adrenal Cortex Hormones; Alitretinoin; Chronic Disease; Dermatologists; Eczema; Hand Dermatoses; Health Care Surveys; Humans; Keratolytic Agents; Practice Patterns, Physicians'; PUVA Therapy; Tretinoin; United Kingdom

Alitretinoin is approved for the treatment of adults with severe chronic hand eczema (CHE) refractory to potent topical steroids. In the 6 years since launch, approximately 250 000 patients have been treated with alitretinoin.. To compare the postmarketing safety surveillance experience of alitretinoin with data from clinical trials and key safety issues with other retinoids.. An integrated safety analysis of the pivotal studies of alitretinoin and postmarketing adverse event (AE) reports received since approval for alitretinoin were analyzed.. In the pivotal trials, headache, erythema, nausea, increased blood triglycerides and increased blood creatinine phosphokinase were the most frequently reported AEs. Headache, hyperlipidemia and nausea were also frequently reported postmarketing AEs, but depression was relatively more frequently reported than in the pivotal trials. Inflammatory bowel disease and benign intracranial hypertension were rare, and very few cases have been reported in postmarketing surveillance. There have been no reports of teratogenicity in humans consequent to fetal exposure.. Safety data collected in pivotal trials and postmarketing surveillance suggest that alitretinoin is well tolerated by patients with CHE with a relatively low incidence of serious reactions. The adverse reaction profile is congruent with reported effects of other marketed oral retinoids.

Topics: Adult; Alitretinoin; Chronic Disease; Eczema; Female; Hand Dermatoses; Headache; Humans; Pregnancy; Tretinoin

Hand eczema affects nearly 10% of the population. The condition becomes severe and chronic in 5% to 7% of cases and is refractory to topical corticosteroids in 2% to 4%. This study aimed to describe the current use of oral alitretinoin in treating Spanish national health system patients with hand eczema that is refractory to potent topical corticosteroids.. Observational, descriptive, exploratory, cross-sectional study based on the retrospective analysis of records for patients with hand eczema treated with alitretinoin in the Spanish national health system.. We reviewed the records for 62 patients in 13 hospitals in 5 different administrative areas (autonomous communities) of Spain. Alitretinoin was usually used at a dosage of 30mg/d. In most cases the physician judged the clinical response to be satisfactory after a single cycle. The recorded adverse effects were foreseeable and of the type reported for systemic retinoids. The dermatologists agreed that the clinical benefits achieved with alitretinoin favored adherence to treatment and an early return to work.. The results show that oral alitretinoin is being used according to established recommendations and that response is good, with few adverse effects. The dermatologists agreed that the benefits favored adherence and improved the patients' health related quality of life.

Topics: Alitretinoin; Chronic Disease; Cross-Sectional Studies; Eczema; Hand Dermatoses; Humans; Retrospective Studies; Spain; Tretinoin

Topics: Adult; Alitretinoin; Dermatologic Agents; Eczema; Follow-Up Studies; Hand Dermatoses; Headache; Humans; Male; Time Factors; Tretinoin

Topics: Administration, Oral; Alitretinoin; Dermatologic Agents; Female; Foot Dermatoses; Hand Dermatoses; Humans; Keratoderma, Palmoplantar; Treatment Outcome; Tretinoin; Young Adult

Acitretin has been used off-label for years to treat chronic hand eczema, but acitretin is less often prescribed as alitretinoïne was approved. This study evaluates both retinoids in a daily practice cohort of patients with severe chronic hand eczema in terms of drug survival and reasons for discontinuation. Patients using alitretinoin or acitretin between 01-01-1994 and 01-08-2015 were included in this retrospective daily practice study and analyzed by Kaplan-Meier drug survival curves. Potential determinants were analyzed by Cox regression analyses. Ninety-five patients were treated with alitretinoin and 109 patients with acitretin. The main reasons for discontinuation were adverse events and cleared hand eczema, 29.5 and 27.4% in alitretinoin versus 43.1 and 23.9% in acitretin. Patients with hyperkeratotic hand eczema had most often a good effect of treatment: 68.3% in alitretinoin and 50.7% in acitretin treatment. The drug survival rates of alitretinoin and acitretin after 12, 24, 36, and 52 weeks were 69.3, 45.1, 19.6, 7.0% and 74.3, 45.5, 33.8, 23.2%, respectively. Alitretinoin and acitretin are effective treatment options for patients with hand eczema. However, both treatments were more effective in patients with hyperkeratotic hand eczema. Fewer patients discontinued alitretinoin compared with acitretin due to adverse events.

Topics: Acitretin; Adult; Aged; Alitretinoin; Chronic Disease; Dermatologic Agents; Eczema; Female; Hand Dermatoses; Humans; Kaplan-Meier Estimate; Keratosis; Male; Middle Aged; Proportional Hazards Models; Remission Induction; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome; Tretinoin

Chronic hand eczema (CHE) is a common inflammatory skin disease that affects approximately 10% of the population. Systemic alitretinoin has been shown to be effective in patients with CHE who are refractory to topical corticosteroids.. To analyse the impact of alitretinoin on the skin barrier genes and protein expression in the skin lesions of patients with CHE.. Fifteen patients with CHE were treated with 30 mg daily of alitretinoin for up to 27 weeks. Disease severity was assessed using a clinical score. Skin biopsies from all the patients were evaluated before and after therapy for the expression of Ki-67, various skin barrier genes and thymic stromal lymphopoietin (TSLP) by real-time quantitative polymerase chain reaction and immunohistochemistry.. After alitretinoin application, an improvement in the clinical severity of CHE was observed in the majority of patients. Analysis of skin biopsies before treatment showed a significant increase in Ki-67-positive cells in the suprabasal layer and a dysregulated expression of various skin barrier genes, such as claudin 1, loricrin, filaggrin and cytokeratin 10, which were normalized after treatment. TSLP was significantly upregulated in patients with CHE and also normalized after alitretinoin treatment and negatively correlated with filaggrin.. Our data indicate that the expression of barrier genes and proteins was normalized following treatment with alitretinoin in patients with CHE. The change in expression levels of these genes correlated with the clinical efficacy, suggesting that alitretinoin exhibits a disease-modifying activity. TSLP is upregulated in CHE and seems to counteract filaggrin expression in the skin.

Topics: Administration, Cutaneous; Adult; Aged; Alitretinoin; Chronic Disease; Dermatologic Agents; Drug Administration Schedule; Eczema; Epidermis; Female; Filaggrin Proteins; Gene Expression; Hand Dermatoses; Humans; Ki-67 Antigen; Male; Middle Aged; Tight Junction Proteins; Tretinoin

Severe chronic hand eczema (CHE) has a debilitating effect on quality of life (QoL). PASSION evaluated the effectiveness of oral alitretinoin on QoL and work productivity in patients with severe CHE following prescribing guidelines.. A non-interventional, open-label, observational, multicentre study conducted in Germany in fulfilment of German guidelines. Patients (n = 631) were treated with once-daily alitretinoin for ≤24 weeks under standard daily practise conditions. Effectiveness was assessed by Physician Global Assessment (PGA), QoL Assessment (EQ-5D) and work impairment. Tolerability and safety were assessed by adverse event (AE) monitoring.. In total, 279 (44.2%) patients dropped out before Week 24. Of the 631 patients enrolled, 29.8% achieved a PGA rating of clear/almost clear at Week 24. Mean (standard deviation) EQ-5D utility and EQ-5D visual analogue scale scores at baseline were 0.76 (0.25) and 53.6 (23.55), respectively, and increased to 0.94 (0.12) and 80.8 (19.23) at Week 24, indicating improved QoL. At baseline, 49.4%/29.1% of patients reported strong/very strong workplace impairment, respectively, and decreased to 8.5%/1.4%, respectively, at Week 24. AEs were reported in 116 (18.4%) patients. No new safety signals were observed.. Alitretinoin produced marked improvement in the QoL and work productivity of patients with severe CHE.

Topics: Alitretinoin; Antineoplastic Agents; Chronic Disease; Dermatologic Agents; Eczema; Female; Hand Dermatoses; Humans; Male; Middle Aged; Quality of Life; Tretinoin

Alitretinoin is the only approved treatment for severe chronic hand eczema (CHE) refractory to potent topical corticosteroids. This study (FUGETTA) evaluated the effectiveness and impact on quality of life (QoL) of oral alitretinoin in patients with severe refractory CHE in accordance with prescription guidelines.. Open-label, multicenter, noninterventional, observational study conducted in Germany. Patients were treated at their physician's discretion with once-daily alitretinoin 10 mg or 30 mg for a maximum of 24 weeks. Effectiveness was assessed by Physician Global Assessment (PGA) and Dermatology Life Quality Index (DLQI). Adverse events (AEs) were assessed.. The study population included 658 patients (30 mg n = 581; 10 mg n = 77). At baseline, most patients had CHE characterized as severe by PGA (83 %). At last visit, 48 % of patients had a PGA response of clear/almost clear (30 mg: 49 %; 10 mg: 43 %). Mean improvement in DLQI scores at week 24 was 58 % (30 mg: mean [SD] change from baseline -10.4 [8.04]) and 70 % (10 mg: mean [SD] change from baseline -10.8 [7.29]). The overall incidence of AEs was low and similar in both groups.. Alitretinoin produced rapid, marked improvement in QoL of patients with severe CHE.

Topics: Administration, Cutaneous; Adolescent; Adult; Age Distribution; Alitretinoin; Chronic Disease; Dermatologic Agents; Dose-Response Relationship, Drug; Eczema; Female; Germany; Hand Dermatoses; Humans; Middle Aged; Patient Satisfaction; Prevalence; Quality of Life; Severity of Illness Index; Sex Distribution; Treatment Outcome; Tretinoin; Women's Health; Young Adult

Topics: Alitretinoin; Antineoplastic Agents; Female; Foot Dermatoses; Hand Dermatoses; Humans; Middle Aged; Mycosis Fungoides; Skin Neoplasms; Treatment Outcome; Tretinoin

The aim of the CARPE registry is to investigate characteristics and medical care in patients affected by chronic hand eczema. Patients are assessed by dermatological examination and patient questionnaire. Socio-economic and clinical data are collected, and quality of life is measured using the Dermatology Life Quality Index (DLQI). A total of 1,163 patients with chronic hand eczema were eligible for analysis (mean age 47.0 years; 54.6% female; mean disease duration 7.6 years). At inclusion, chronic hand eczema was very severe in 23.4%, severe in 47.0%, moderate in 20.1%, and clear or almost clear in 9.6% of patients. Median DLQI was 8.0. In all, 93.8% of patients reported use of topical corticosteroids, 25.6% systemic antihistamines, 28.3% topical calcineurin-inhibitors, 38.0% ultraviolet phototherapy, and 35.3% systemic treatment (19.7% alitretinoin) prior to inclusion in the registry. A significant proportion of patients may not receive adequate treatment according to the guideline on management of hand eczema.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Alitretinoin; Calcineurin Inhibitors; Chronic Disease; Eczema; Female; Germany; Glucocorticoids; Hand Dermatoses; Histamine Antagonists; Humans; Male; Middle Aged; Occupations; Pruritus; Quality of Life; Registries; Severity of Illness Index; Tretinoin; Ultraviolet Therapy; Young Adult

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Alitretinoin; Dermatologic Agents; Female; Hand Dermatoses; Humans; Male; Middle Aged; Quality of Life; Tretinoin; Young Adult

Topics: Alitretinoin; Chronic Disease; Cyclosporine; Dermatologic Agents; Drug Substitution; Eczema; Foot Dermatoses; Hand Dermatoses; Humans; Male; Middle Aged; Nail Diseases; Nails, Malformed; Time Factors; Treatment Outcome; Tretinoin

The treatment of moderate to severe chronic hand dermatitis (CHD) has been advanced with the introduction of alitretinoin (9-cis-retinoic acid). Although clinical trial data demonstrated the efficacy and safety of alitretinoin, real-world experience is lacking in a more generalized patient population.. Patients with CHD often, and unsuccessfully, attempt several therapeutic options before seeing a dermatologist. This chart review study aimed to examine the experience of using alitretinoin for CHD in a dermatology office setting.. A retrospective chart review of electronic medical records was conducted of all patients prescribed alitretinoin in a community dermatology practice.. Alitretinoin was well tolerated in this patient population of 53 patients and showed a clinically significant reduction in disease symptoms.. Alitretinoin was a safe and well-tolerated treatment with significant clinical improvement in our patient population. Few clinically significant laboratory abnormalities were identified, and only one patient discontinued therapy due to adverse events.

Topics: Adult; Aged; Alitretinoin; Chronic Disease; Community Health Services; Dermatologic Agents; Dermatology; Female; Hand Dermatoses; Humans; Male; Middle Aged; Retreatment; Retrospective Studies; Treatment Outcome; Tretinoin

Topics: Administration, Oral; Aged; Alitretinoin; Antineoplastic Agents; Biopsy, Needle; Dose-Response Relationship, Drug; Drug Administration Schedule; Follow-Up Studies; Hand Dermatoses; Humans; Immunohistochemistry; Male; Pityriasis Rubra Pilaris; Severity of Illness Index; Treatment Outcome; Tretinoin

This non-interventional observational open study (TOCCATA, sponsored by Basilea Pharmaceutica Germany) investigated the use of alitretinoin to treat chronic hand eczema under daily "real life" medical practice conditions in Germany. A total of 349 dermatologists through-out Germany enrolled 680 adult patients with chronic hand eczema. Patients were prescribed and treated with alitretinoin in accordance with the summary of product characteristics. The maximum observation duration was 24 weeks, with efficacy and safety parameters evaluated every 4 weeks. Efficacy was primarily evaluated by assessing disease severity according to the Physician Global Assessment. In total, 56.7% of patients achieved a Physician Global Assessment rating of "clear" or "almost clear" hands, with only small differences in patients with different morphological forms: hyperkeratotic-rhagadiform (59.2%), fingertip (52.2%) and vesicular (47.9%). This observational study demonstrates the effectiveness and tolerability of alitretinoin in everyday clinical practice in addition to the known efficacy and safety obtain-ed by randomized controlled clinical trials.

Topics: Adult; Alitretinoin; Chronic Disease; Eczema; Female; Hand Dermatoses; Humans; Keratolytic Agents; Male; Middle Aged; Severity of Illness Index; Tretinoin

Chronic hand eczema is a frequent cause of consultation. In Europe and Switzerland, it's one of the main reasons for patients to interrupt their profession. The etiology is pluri-factorial. Atopic patients are more likely predisposed. Pruritus, associated to pain and bleeding, is intense. Psychosocial consequences are huge, making this illness to an important public health problem. Topical treatment and UV-light are the main therapeutical strategy but the results are often disappointing. Recently, alitretinoine (9-cis retinoic acid) became the treatment of second choice with good response, allowing patients to preserve a good quality of life and their job.

Topics: Algorithms; Alitretinoin; Dermatologic Agents; Eczema; Hand Dermatoses; Humans; Phototherapy; Radiotherapy; Tretinoin

  In a previous large trial (Benefit of Alitretinoin in Chronic Hand Eczema; BACH), 47.7% of patients with severe chronic hand eczema (CHE) who received alitretinoin 30 mg achieved 'clear' or 'almost clear' hands during the initial 24-week treatment course..   The current open-label trial was designed to study extended treatment with a further 12- to 24-week course of oral alitretinoin 30 mg in patients who did not fully respond to initial treatment in the BACH study..   At the end of the BACH study, patients whose eczema was rated 'mild', 'moderate' or 'severe' according to the Physician's Global Assessment (PGA) were eligible for a 24-week, open-label, multicentre study. Patients (n=243) received 30 mg of alitretinoin once daily, irrespective of previous treatment in BACH; either alitretinoin 30 mg, alitretinoin 10 mg or placebo..   By the end of the follow-on study, the PGA response rate to the subsequent course of alitretinoin 30 mg was 50% and 39% in patients treated previously in BACH with 10 or 30 mg per day, respectively, and 51% in patients who previously received placebo in BACH. Alitretinoin was well tolerated, and no significant late-arising toxicities were seen.. For a considerable number of patients with CHE who did not fully respond after an initial 24-week treatment period, a switch from either placebo to the active compound at 30 mg or from the lower to the higher dose, or treatment prolongation at the higher dose could be beneficial. Alitretinoin remains well tolerated for overall treatment durations of up to 48 weeks.

Topics: Administration, Oral; Adult; Alitretinoin; Canada; Chronic Disease; Dermatologic Agents; Eczema; Europe; Female; Hand Dermatoses; Humans; Male; Middle Aged; Retreatment; Tretinoin

Chronic hand eczema (CHE) is a debilitating and distressing disease for patients, the physical symptoms of which are compounded by psychosocial problems. Alitretinoin is an endogenously occurring physiological vitamin A derivative (retinoid) that possesses strong anti-inflammatory and immunomodulatory activity. It is currently the only licensed product for severe CHE unresponsive to treatment with potent topical corticosteroids, and has been proven to be highly effective in clinical trials with two-thirds of patients who responded to treatment remaining in remission at 6 months. For those that did relapse, a second study showed they could be successfully retreated with a further 3-6 month course of alitretinoin. Seven case studies of alitretinoin have been provided by consultant dermatologists showing its use in normal UK clinical practice. The cases chosen demonstrate the efficacy of alitretinoin across several different subtypes of CHE, and the positive effects the treatment brought to patients' quality of life.

Topics: Alitretinoin; Chronic Disease; Dermatologic Agents; Eczema; Hand Dermatoses; Humans; Tretinoin

Topics: Alitretinoin; Dermatitis, Allergic Contact; Dermatitis, Occupational; Dermatologic Agents; Gardening; Hand Dermatoses; Humans; Male; Middle Aged; Tretinoin

Topics: Adult; Alitretinoin; Animal Husbandry; Animals; Dermatitis, Occupational; Dermatologic Agents; Female; Foot Dermatoses; Hand Dermatoses; Horses; Humans; Tretinoin

Topics: Adult; Alitretinoin; Dermatologic Agents; Foot Dermatoses; Hand Dermatoses; Humans; Keratoderma, Palmoplantar; Male; Tretinoin

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

Topics: Alitretinoin; Chronic Disease; Dermatologic Agents; Female; Foot Dermatoses; Hand Dermatoses; Humans; Middle Aged; Politics; Quality of Life; Tretinoin

Topics: Alitretinoin; Chronic Disease; Dermatologic Agents; Engineering; Hand Dermatoses; Humans; Male; Middle Aged; Tretinoin

Topics: Adult; Alitretinoin; Chronic Disease; Dermatologic Agents; Hand Dermatoses; Humans; Information Science; Male; Tretinoin

Topics: Alitretinoin; Dermatologic Agents; Drug Interactions; Female; Hand Dermatoses; Humans; Male; Tretinoin

Topics: Administration, Oral; Adult; Alitretinoin; Chronic Disease; Dermatitis, Atopic; Dermatologic Agents; Female; Hand Dermatoses; Humans; Male; Middle Aged; Treatment Outcome; Tretinoin; Young Adult

Topics: Alitretinoin; Chronic Disease; Eczema; Hand Dermatoses; Humans; Keratolytic Agents; Tretinoin

Topics: Alitretinoin; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Cetuximab; Cost-Benefit Analysis; Decision Making, Organizational; Dermatologic Agents; Eczema; Evidence-Based Medicine; Federal Government; Hand Dermatoses; Head and Neck Neoplasms; Humans; Internationality; National Health Programs; Neoplasms, Squamous Cell; Peer Review; Quality-Adjusted Life Years; Technology Assessment, Biomedical; Treatment Outcome; Tretinoin; United Kingdom

The management of chronic hand eczema is often inadequate. There are currently no evidence-based guidelines specifically for the management of chronic hand eczema, and evidence for established treatments for hand eczema is not of sufficient quality to guide clinical practice. This consensus statement, based on a review of published data and clinical practice in both primary and secondary care, is intended to guide the management of chronic hand eczema. It describes the epidemiology and pathogenesis of hand eczema, its diagnosis and its effect on patients' quality of life. Management strategies include a skin education programme, lifestyle changes, and the use of emollients, barriers and soap substitutes. Topical drug therapy includes topical steroids and calcineurin inhibitors. Treatment with psoralen ultraviolet A and systemic therapies may then be appropriate, although there is no strong evidence of efficacy. Alitretinoin has been shown to be effective in a randomized controlled trial, and is currently the only treatment specifically licensed for the treatment of hand eczema. Recommendations for management are summarized in a treatment algorithm.

Topics: Alitretinoin; Chronic Disease; Dermatologic Agents; Emollients; Glucocorticoids; Hand Dermatoses; Humans; Quality of Life; Referral and Consultation; Tretinoin

Topics: Alitretinoin; Dermatologic Agents; Dermatology; Eczema; Hand Dermatoses; Humans; Tretinoin

Topics: Administration, Topical; Adult; Aged; Alitretinoin; Drug Administration Schedule; Female; Follow-Up Studies; Gels; Granuloma, Pyogenic; Hand Dermatoses; Humans; Treatment Outcome; Tretinoin

A methyl salicylate-buffered, croton oil-containing 50% salicylic acid ointment peel, following pretreatment with topical tretinoin and localized 20% trichloroacetic acid, is extremely effective for removal of lentigines, pigmented keratoses, and actinically damaged skin from the dorsum of the hands and forearms. The ease of application, uniform results, decreased risk of scarring, and one-time application of this peel, in comparison with other methods used for treatment of these aging-skin changes, warrants consideration by the dermatologic surgeon.

Topics: Aged; Bandages; Chemexfoliation; Dermatitis, Seborrheic; Female; Forearm; Hand Dermatoses; Humans; Keratosis; Lentigo; Ointments; Pigmentation Disorders; Salicylates; Salicylic Acid; Tretinoin; Trichloroacetic Acid

The effects of acitretin (free acid of etretinate) on the serum lipoprotein pattern and on the fat elimination in serum of 8 patients with psoriasis and 4 with palmo-plantar pustulosis were studied. The drug was given for 12 weeks; the average daily dose was 40 mg. Lipoprotein analyses and an intravenous fat tolerance test (IVFTT) were performed on three occasions (before, after 8 weeks' treatment, as well as 8 weeks after the end of the treatment). Acitretin increased the triglyceride concentration of the very low density lipoproteins by about 50% (p less than 0.02) and reduced the cholesterol of the high density lipoproteins significantly (p less than 0.001), leading to an increased low density/high density lipoprotein cholesterol ratio (p less than 0.02). The IVFTT indicated a lowering of the fat elimination capacity. All changes reverted to the original values after an 8-week wash-out period. The data suggest that the effects of acitretin on the lipoprotein metabolism resemble those of etretinate and isotretinoin.

Topics: Acitretin; Adult; Apolipoproteins; Cholesterol; Fat Emulsions, Intravenous; Female; Foot Dermatoses; Hand Dermatoses; Humans; Lipids; Lipoproteins; Male; Middle Aged; Psoriasis; Skin Diseases, Vesiculobullous; Tretinoin

A disabling case of keratodermia palmoplantare papuloverrucoides progressiva is described. Less severe cases have been reported in the American literature as keratodermia punctata. The verrucoid lesions of our patient were spontaneously shed during treatment with the aromatic retinoid etretinate, and a daily maintenance dose of 25 mg was necessary to prevent recurrence.

Topics: Adult; Etretinate; Foot Dermatoses; Hand Dermatoses; Humans; Keratoderma, Palmoplantar; Male; Middle Aged; Tretinoin; Warts

Topics: Adult; Cell Migration Inhibition; Chemotaxis, Leukocyte; Etretinate; Female; Hand Dermatoses; Humans; Male; Middle Aged; Neutrophils; Skin Diseases, Vesiculobullous; Suppuration; Tretinoin

Topics: Adult; Etretinate; Facial Dermatoses; Hand Dermatoses; Humans; Male; Sarcoidosis; Tretinoin; Warts

Topics: Eczema; Etretinate; Female; Foot Dermatoses; Hand Dermatoses; Humans; Keratoderma, Palmoplantar; Male; Middle Aged; Tretinoin

Topics: Administration, Oral; Aged; Etretinate; Female; Foot Dermatoses; Hand Dermatoses; Humans; Psoriasis; Tretinoin

Linear porokeratosis is a rare variant of porokeratosis of Mibelli and usually occurs in childhood. A 15-year-old boy is presented with typical clinical lesions of linear porokeratosis on the extensor surface of the right arm exhibiting the classical histopathologic criteria of the disease. Treatment with an oral aromatic retinoid resulted in a remission of the lesion.

Topics: Administration, Oral; Adolescent; Etretinate; Foot Dermatoses; Hand Dermatoses; Humans; Keratosis; Male; Syndrome; Tretinoin

2 patients with widespread porokeratosis Mibelli (PM) were treated orally with RO 10-9359. The dose was 75 mg/day for 10 days, then 50 mg/day for 3 weeks. The drug produced a good improvement of condition with no serious side effect. Ultrastructural examination of a healed lesion showed the presence of a fine granular substance in the intercellular space of the spinous layer, most likely produced by keratinocytes; ultrastructural cellular alterations of PM were still evident and the lesion recurred after suspension of treatment.

Topics: Aged; Etretinate; Foot Dermatoses; Hand Dermatoses; Humans; Keratosis; Male; Middle Aged; Skin; Syndrome; Tretinoin

Topics: Administration, Topical; Adult; Drug Evaluation; Female; Foot Dermatoses; Hand Dermatoses; Humans; Keratosis; Syndrome; Tretinoin; Vitamin A