Alitretinoin an Effective Option in Children With Hand Eczema

eczema on hand
eczema on hand
A new study adds to the limited data on the use of alitretinoin in pediatric patients with hand eczema and finds efficacy in treatment that is similar to adults.

Study data published in the Journal of the European Academy of Dermatology and Venereology support the safety and efficacy of alitretinoin for the treatment of hand eczema in children.

Investigators conducted a retrospective chart review of all consecutive patients (≤18 years) treated with alitretinoin at the Pediatric Skin Center of the University Children’s Hospital Zurich, Switzerland, from 2014 to 2018. Sociodemographic and clinical characteristics were extracted from medical records. Investigators also assessed alitretinoin dose, treatment duration, and adverse events. All eligible patients had regular follow-up visits before treatment, 4 to 6 weeks after treatment initiation, and every 3 months thereafter.

The primary outcome measure was change in Physician’s Global Assessment score across the study period. Achieving a Physician’s Global Assessment of 0 to 1 or a reduction of 2+ points was considered an “excellent” treatment response, and a reduction of 1 point was considered moderate response. The hand eczema severity index (HECSI-Score) was also used in patients with chronic hand eczema (CHE).

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A total of 13 patients were enrolled in the study, of whom 9 (69%) were girls. The median age at alitretinoin initiation was 11.5 years (range, 5.8-15.8 years). Participant diagnoses included CHE (n=9), severe atopic dermatitis (n=2), and Netherton syndrome and autosomal recessive congenital ichthyosis (n=2). Moderate to excellent treatment response (Physician’s Global Assessment decrease ≥1 point) was observed in 7 (78%) of 9 patients with CHE, 1 (50%) of 2 patients with atopic dermatitis, and the 1 patient with autosomal recessive congenital ichthyosis. In the remaining 4 patients, no significant treatment effect was observed. Median time to response in patients with CHE was 2.5 months (range, 1-6 months), and a 50% improvement in HECSI-Score was achieved by 5 patients (56%). The most common adverse effect was headache, reported by 10 (77%) patients during treatment. One patient stopped therapy because of headaches, and 1 required alitretinoin dose reduction.

Overall, alitretinoin was well tolerated in a cohort of pediatric patients with hand eczema. Excellent to moderate treatment response was observed in the majority of participants. Data generalizability was limited by the retrospective study design and small cohort size. The study cohort was also highly heterogenous in terms of dermatological diagnosis. Further study is needed to explore the treatment effects of alitretinoin in children with refractory CHE and other inflammatory skin conditions.

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Luchsinger I, Vogler T, Schwieger-Briel A, et al. Safe and effective use of Alitretinoin in children with recalcitrant hand eczema and other dermatoses – a retrospective analysis [published online November 19, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.16088