A controlled study of comparative efficacy of oral retinoids and topical betamethasone/salicylic acid for chronic hyperkeratotic palmoplantar dermatitis.
BACKGROUND
Chronic hyperkeratotic dermatitis of the palms and soles represents a severe multi-etiological problem, too often faced with ineffective or tedious topical remedies.


METHODS
A single-blind, matched-sample design investigation was carried out of 42 patients with chronic hyperkeratotic palmoplantar dermatitis, who were administered acitretin 25-50 mg/day for 1 month, which was controlled versus a conventional topical treatment (betamethasone/salicylic acid ointment). Therapeutic improvement was expressed with the reduction of severity score (expressed on a 0-10 scale).


RESULTS
Acitretin was significantly better than the conventional treatment after 30 days (two sided p<0.0001). Moreover, improvement significantly persisted 5 months after suspension of acitretin (p<0.0001), while this was not the case after suspension of the control treatment (p=0.3019). Lesions improved more rapidly with acitretin than with the control treatment (p<0.0002). Some cases of loss of sensitization in patch-test-positive patients were observed. Side effects were minimal or absent, and patients expressed overtly their preference for acitretin treatment.


CONCLUSIONS
After evaluating the former literature, the risks and the benefits, as well as the overt superiority of retinoid treatment, the authors conclude that acitretin should be considered a first choice treatment for this fastidious condition.
Capella
Giovanni Luigi
GL
Istituto di Dermatologia dell'Università, Milan, Italy. aldo.finzi@unimi.it
Fracchiolla
Claudio
C
Frigerio
Elena
E
Altomare
Gianfranco
G
D017255:Acitretin / Q000008:administration & dosage*; D000279:Administration, Cutaneous; D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D001623:Betamethasone / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007645:Keratoderma, Palmoplantar / Q000188:drug therapy* / Q000473:pathology; D007641:Keratolytic Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D020156:Salicylic Acid / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
D005938:Glucocorticoids; D007641:Keratolytic Agents; D001623:Betamethasone; D017255:Acitretin; D020156:Salicylic Acid