Ann Dermatol.  2019 Dec;31(6):595-600. 10.5021/ad.2019.31.6.595.

Efficacy and Safety of Alitretinoin Therapy in Korean Elderly Patients with Chronic Hand Eczema: A Retrospective Single Center Study

Affiliations
  • 1Department of Dermatology, Veterans Health Service Medical Center, Seoul, Korea. zooooz@hanmail.net
  • 2Division of Dermatology, Department of Medicine, Hanyang University Graduate School, Seoul, Korea.
  • 3Department of Dermatology, Gachon University of Medicine and Science, Incheon, Korea.

Abstract

BACKGROUND
Chronic hand eczema (CHE) tends to be refractory to conventional therapy. Previous clinical trials have found that alitretinoin is an effective and well-tolerated treatment for CHE. However, there is a relative lack of data on the effectiveness of alitretinoin in elderly patients.
OBJECTIVE
The aim of this study was to investigate the efficacy and safety of oral alitretinoin in elderly patients with moderate to severe CHE in Korea.
METHODS
We retrospectively investigated 46 CHE patients who were treated with either 10 mg or 30 mg of alitretinoin between June of 2016 and July of 2018. The physician's global assessment (PGA) was used to evaluate treatment efficacy. All adverse events were retrospectively evaluated with respect to laboratory testing, including complete blood cell count, fasting blood chemistry, lipid profile, and liver and thyroid function tests.
RESULTS
The mean patient age in this study was 71.0±5.1 years. The treatment period was over eight weeks. A total of 38 of 46 patients (82.6%) exhibited clinical improvement with PGA ratings of "˜clear' or "˜almost clear.' There were 13 patients (28.3%) who experienced an adverse effect, with the most common being headache (13.0%) and gastrointestinal symptoms (8.7%) followed by xerosis (6.5%). A total of 13 patients developed or exhibited worsening hypertriglyceridemia (28.3%).
CONCLUSION
Alitretinoin can be considered a safe and effective treatment option in elderly patients with moderate to severe CHE.

Keyword

Alitretinoin; Efficacy; Elderly; Hand eczema; Korea; Safety

MeSH Terms

Aged*
Blood Cell Count
Chemistry
Eczema*
Fasting
Hand*
Headache
Humans
Hypertriglyceridemia
Korea
Liver
Retrospective Studies*
Thyroid Function Tests
Treatment Outcome

Figure

  • Fig. 1 Evaluation of physician's global assessment (PGA) according to severity of chronic hand eczema (CHE) at baseline.


Reference

1. Van Coevorden AM, Coenraads PJ, Svensson A, Bavinck JN, Diepgen TL, Naldi L, et al. European Dermato-Epidemiology Network (Eden). Overview of studies of treatments for hand eczema-the EDEN hand eczema survey. Br J Dermatol. 2004; 151:446–451. PMID: 15327553.
Article
2. Thyssen JP, Johansen JD, Linneberg A, Menné T. The epidemiology of hand eczema in the general population--prevalence and main findings. Contact Dermatitis. 2010; 62:75–87. PMID: 20136890.
3. Diepgen TL, Agner T, Aberer W, Berth-Jones J, Cambazard F, Elsner P, et al. Management of chronic hand eczema. Contact Dermatitis. 2007; 57:203–210. PMID: 17868211.
Article
4. Ruzicka T, Lynde CW, Jemec GB, Diepgen T, Berth-Jones J, Coenraads PJ, et al. Efficacy and safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial. Br J Dermatol. 2008; 158:808–817. PMID: 18294310.
Article
5. King T, McKenna J, Alexandroff AB. Alitretinoin for the treatment of severe chronic hand eczema. Patient Prefer Adherence. 2014; 8:1629–1634. PMID: 25525339.
6. Ruzicka T, Larsen FG, Galewicz D, Horváth A, Coenraads PJ, Thestrup-Pedersen K, et al. Oral alitretinoin (9-cis-retinoic acid) therapy for chronic hand dermatitis in patients refractory to standard therapy: results of a randomized, double-blind, placebo-controlled, multicenter trial. Arch Dermatol. 2004; 140:1453–1459. PMID: 15611422.
Article
7. Prakash AV, Davis MD. Contact dermatitis in older adults: a review of the literature. Am J Clin Dermatol. 2010; 11:373–381. PMID: 20812765.
8. Politiek K, Christoffers WA, Coenraads PJ, Schuttelaar MA. Alitretinoin and acitretin in severe chronic hand eczema; results from a retrospective daily practice study. Dermatol Ther. 2016; 29:364–371. PMID: 27146260.
Article
9. Kwon HI, Kim JE, Ko JY, Ro YS. Efficacy and safety of alitretinoin for chronic hand eczema in Korean patients. Ann Dermatol. 2016; 28:364–370. PMID: 27274636.
Article
10. Fowler JF, Graff O, Hamedani AG. A phase 3, randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of alitretinoin (BAL4079) in the treatment of severe chronic hand eczema refractory to potent topical corticosteroid therapy. J Drugs Dermatol. 2014; 13:1198–1204. PMID: 25607554.
11. Dirschka T, Reich K, Bissonnette R, Maares J, Brown T, Diepgen TL. An open-label study assessing the safety and efficacy of alitretinoin in patients with severe chronic hand eczema unresponsive to topical corticosteroids. Clin Exp Dermatol. 2011; 36:149–154. PMID: 21070335.
Article
12. Bissonnette R, Worm M, Gerlach B, Guenther L, Cambazard F, Ruzicka T, et al. Successful retreatment with alitretinoin in patients with relapsed chronic hand eczema. Br J Dermatol. 2010; 162:420–426. PMID: 19906075.
Article
13. Rosenson RS, Kastelein JJP. Hypertriglyceridemia [Internet]. Waltham, MA: UpToDate;2019. updated 2019 May 13. cited 2019 July 30. Available from: https://www.uptodate.com/contents/hypertriglyceridemia.
14. Diepgen TL, Elsner P, Schliemann S, Fartasch M, Köllner A, Skudlik C, et al. Deutsche Dermatologische Gesellschaft. Guideline on the management of hand eczema ICD-10 Code: L20. L23. L24. L25. L30. J Dtsch Dermatol Ges. 2009; 7 Suppl 3:S1–S16.
Article
15. Al-Dhubaibi MS, Settin AA. The effectiveness of alitretinoin for the treatment of chronic hand eczema: a meta-analysis. Int J Health Sci (Qassim). 2018; 12:70–79.
16. Schmitt-Hoffmann AH, Roos B, Schoetzau A, Leese PT, Meyer I, van de Wetering J, et al. Oral alitretinoin: a review of the clinical pharmacokinetics and pharmacodynamics. Expert Rev Clin Pharmacol. 2012; 5:373–388. PMID: 22943117.
Article
17. Krejci-Manwaring J, McCarty MA, Camacho F, Carroll CL, Johnson K, Manuel J, et al. Adherence with topical treatment is poor compared with adherence with oral agents: implications for effective clinical use of topical agents. J Am Acad Dermatol. 2006; 54(5 Suppl):S235–S236. PMID: 16631951.
Article
18. Tanei R. Atopic dermatitis in the elderly. Inflamm Allergy Drug Targets. 2009; 8:398–404. PMID: 20025588.
Article
19. Schmith GD, Singh R, Gomeni R, Graff O, Hamedani AG, Troughton JS, et al. Use of longitudinal dose-response modeling to support the efficacy and tolerability of alitretinoin in severe refractory chronic hand eczema (CHE). CPT Pharmacometrics Syst Pharmacol. 2015; 4:255–262. PMID: 26225249.
Article
20. Pesante-Pinto JL. Clinical pharmacology and the risks of polypharmacy in the geriatric patient. Phys Med Rehabil Clin N Am. 2017; 28:739–746. PMID: 29031340.
Article
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