In Some Patients, Alitretinoin Cleared Severe Hand Eczema After Standard Treatment Failed
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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.
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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