New Drug Relieves Hand Eczema
In Some Patients, Alitretinoin Cleared Severe
Hand Eczema After Standard Treatment Failed
By Charlene Laino
WebMD Health News
Reviewed by Laura J. Martin, MD
March 8, 2010 (Miami Beach, Fla.) -- A new drug called alitretinoin can help
relieve cracked, itchy, irritated hands in people with severe
hand eczema,
researchers report.
Hands "completely or almost completely" cleared up in nearly half of people
with hand eczema that didn't respond to standard treatment, says Charles Lynde,
MD, assistant professor of dermatology at the University of Toronto.
Up to 10% of people have hand dermatitis, in which the skin becomes inflamed,
typically from an allergic reaction to an irritant, Lynde says. The hand becomes
dry and chapped and eventually red, scaly, and inflamed.
Of those, about 5% have dermatitis as severe as the people in the new
research, he says.
"These were hard-core patients who weren't getting better when treated with
ointments containing corticosteroids," the standard drugs used to reduce
inflammation in people with severe dermatitis. They had suffered for nine or 10
years, on average, Lynde tells WebMD.
"At present, we don't have very much to offer when corticosteroid [ointments]
fail," he says.
Enter alitretinoin, a relative of vitamin A that is approved for severe hand
eczema in some European countries and Canada but not the U.S. It's given in
capsule form, once a day.
At the annual meeting of the American Academy of Dermatology (AAD), Lynde
summarized findings from three studies showing that alitretinoin is effective in
a substantial proportion of these patients.
"The first and second studies show that itching, redness, fissures, and
dryness go away. The third shows it will help if you relapse," he says.
The research was funded by Basilea Pharmaceutica International, which markets
alitretinoin under the brand name Toctino in Europe. Lynde has reported being a
consultant for Basilea.
Alitretinoin Clears Up Severe Hand Dermatitis
The largest of the studies involved 1,032 people with severe hand dermatitis
in Europe and Canada. The patients took a 10-milligram or 30-milligram dose of
alitretinoin, or placebo, once a day for 12 or 24 weeks.
Participants were told to avoid irritants such as detergent that could
trigger or exacerbate their dermatitis.
The skin condition completely or almost completely resolved in 48% of
patients treated with the higher dose of alitretinoin. "That means they were
90%, 95%, 100% improved," Lynde says.
In contrast, 28% of patients treated with the lower dose and 17% of
placebo-treated patients completely or almost completely responded.
The second study involved 249 patients in Europe and Canada. All had suffered
from hand eczema for years. Steroid ointments no longer worked for them, Lynde
says.
All received the higher dose of alitretinoin for up to 24 weeks.
The hand rash cleared up in 47% of patients.
The third study was designed to determine if the drug could help patients who
relapse after treatment with alitretinoin.
"About a third relapsed, so we tried alitretinoin again," Lynde says.
It worked, with the rash resolving in about four-fifths of patients given the
30-milligram dose. In contrast, fewer than 10% of patients given a placebo
responded.
Alitretinoin doesn't work overnight -- it typically takes four to six weeks
to see any change, Lynde says. And not everyone responds.
"But this does offer new hope for dermatitis we thought was incurable.
Patients improve and quite a few go into remission," he says.
The most frequent side effects are headache and dryness and flushing of the
skin, Lynde says. Also, it can cause serious, even fatal birth defects, so
women
who are pregnant or thinking about getting pregnant should never take it, he
says.
Additionally, the medication can make you more sensitive to the sun, so you
may burn more easily, says past AAD president Darrell S. Rigel, MD, clinical
professor of dermatology at New York University Medical Center.
"On the flip side, chronic hand eczema is very hard to treat. If it's so
severe you don't want to go out in public or you're in business and don't want
to shake hands, this appears to offer a good option," he tells WebMD.
SOURCES:
68th Annual Meeting of the American Academy of Dermatology, Miami Beach, Fla.,
March 5-9, 2010.
Charles Lynde, MD, assistant professor of dermatology, University of Toronto.
Darrell S. Rigel, MD, past president, American Academy of Dermatology; clinical
professor of dermatology, New York University Medical Center.
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