Allitretinoin and chronic eczema of hands

Hand eczema is a common dermatosis affecting the hands. Exposure to irritants, allergens and endogenous factors play interrelated roles in the aetiology of this disease. Consequently, it is rarely possible to identify all causative factors and remove them entirely. In a substantial number of patients, hand eczema develops into a chronic condition even when an initial causative agent is avoided. In general, hand dermatitis is considered chronic if it lasts more than 6 months in the absence of external causal factors. Patients with CHE suffer from painful cracks, blisters, itching and bleeding, which can limit manual dexterity and prevent employment[1]. These types of patients with CHE have a poor prognosis; it is a self perpetuating condition with a long-lasting and chronically relapsing course. Mild cases of CHE are usually managed with conscientious use of emollients and topical corticosteroids, and avoidance of irritants, but severe CHE is debilitating if it is refractory to this standard regimen. Severe CHE causes substantial occupational, functional, social and psychological disability, including prolonged sick leave and unemployment, anxiety, low self-esteem, and social phobia. Currently patients with severe CHE refractory to topical corticosteroids have limited treatment options suited for chronic use, and few clinical trials have investigated new therapies in this setting. None of the current treatment options present an alternative to Alitretinoin for the treatment of refractory CHE.