Alitretinoin for the treatment of chronic hand eczema: clinical rationale

Vivian Y Shi, Raja K Sivamani & Howard Maibach

Chronic hand eczema (CHE), an inflammatory skin disease, places heavy psychosocial and economic burden on the affected individual and society as a whole. Patch testing is recommended to identify potential causative allergens in each patient. Efficacy of traditional topical treatments render the management of CHE challenging. Oral alitretinoin (9-cis-retinoic acid) is a new drug for the treatment of severe, refractory CHE. This review summarizes the advances on oral alitretinoin for the treatment of severe CHE, with emphasis on its particular benefit for hyperkeratotic hand eczema, and discusses pharmacodynamics and pharmacokinetics, clinical trials and knowledge gaps.