Low-dose alitretinoin combined with narrowband-UVB was a safe and effective treatment for chronic hand dermatitis (CHD), according to study data published in the Journal of Cutaneous Medicine & Surgery.
Investigators conducted a retrospective review of electronic medical records for adult patients with CHD (hyperkeratotic hand dermatitis, dyshidrotic hand eczema, and fingertip dermatitis) refractory to topical corticosteroids from 2017 to 2020. Investigators treated patients with either low-dose alitretinoin (LDA) 10 mg plus narrowband ultraviolet B therapy (UVB) 3 times weekly, or high-dose alitretinoin (had) 30 mg) daily. Treatment duration was 16 weeks with follow-up every 4 weeks. The primary outcome was response to treatment, defined as achieving “clear” (Physician Global Assessment score [PGA] of 0) or “almost clear” (PGA 1) status after 16 weeks. The secondary outcome was improvement in quality of life (QOL), defined as at least a 50% reduction in the Dermatology Life Quality Index (DLQI) after 16 weeks.
There were a total of 64 patients included: 33 in the LDA-UVB group and 31 in the HDA group. The mean age was 41.25 years (range, 22-62 years), 57.8% were men, and the majority of patients (70.3%) had HHD.
There was a statistically significant improvement in disease severity at 16 weeks in both groups (P <.0001). However, more patients in the LDA-UVB group (63.6%) achieved a PGA 0 or 1 compared with the HDA group (38.7%) after 16 weeks (P <.05).
Both groups reported statistically significant improvements in QOL at 16 weeks (P <.0001). The percentage of those reporting improved QOL in each group was comparable (45.4% in the LDA-UVB group; 48.4% in the HDA group; P >.05), as was the percentage of patients in each group reporting “no” or “small” improvement in their QOL (P >.05), it was noted.
Adverse effects were significantly more common in the HDA cohort at 74.2%, compared with 39.4% in the LDA-UVB cohort (P <.0001). None of the patients discontinued treatment due to adverse effects, and no one experienced serious adverse medical events.
The study was limited by its small sample size and retrospective design.
“Given the promising results of Re-UV [the combination of oral retinoids with UV therapy] in other conditions, the combination may be a welcome addition to the armamentarium for steroid refractory CHD,” the study authors wrote.
Bednar ED, Abu-Hilal M. Low dose oral alitretinoin with narrowband ultraviolet B therapy for chronic hand dermatitis. J Cutan Med Surg. Published online January 23, 2022. doi:10.1177/12034754211071123