Comparative analysis of the efficacy of alitretinoin depending on the concomitant use of topical corticosteroids in chronic hand eczema patients

Abstract

Background: Alitretinoin is the only systemic agent approved for the treatment of severe chronic hand eczema (CHE) unresponsive to potent topical corticosteroids. Clinical trials have proved efficacy of oral alitretinoin with topical emollients for the CHE treatment but most studies have failed to reach a therapeutic success rate of 50%. Reasonably, we thought it would be more effective to combine topical corticosteroids with oral alitretinoin but there have never been studied whether the concomitant use of topical corticosteroids is actually superior Objective: We aimed to investigate the clinical efficacies of oral alitretinoin depending on the concomitant use of topical corticosteroids in chronic hand eczema patients Methods: One hundred seven Korean patients diagnosed as CHE were recruited. The participants were divided into two groups depending on the concomitant use of topical corticosteroids. Comparative analysis was performed between combined therapy group (alitretinoin and topical corticosteroids) and monotherapy group (alitretinoin only) by using physician global assessment (PGA), patient’s global assessment (PaGA), modified total lesion symptom score (mTLSS), and recurrence rates. Results: Combined therapy group showed significantly higher treatment success rate than of alitretinoin monotherapy group for all efficacy parameters (PGA, p<0.001/ PaGA, p<0.001/ mTLSS changes, p<0.001) but there was no significant difference between recurrence rates of both groups (p=0.266). Conclusions: Combined use of topical corticosteroids is recommended to CHE patients being treated with oral alitretinoin due to clinically rapid and superior effectiveness.