title: [Response to treatment with oral alitretinoin in patients with chronic hand eczema that is refractory to treatment with potent topical corticosteroids: experience in 15 patients].
abstract: BACKGROUND
  Alitretinoin (9-cis-retinoic acid) is an endogenous derivative of vitamin A and functions as an agonist of both families of nuclear receptors (retinoic acid receptor-α, -β, -γ; retinoid X receptor-α, -β, -γ). It has been investigated in the treatment of chronic hand eczema in many studies in recent years and the results have been promising.
  
  
  OBJECTIVE
  To evaluate the efficacy and safety of oral alitretinoin in the treatment of chronic hand eczema that is refractory to treatment with potent topical corticosteroids and to analyze the long-term response to treatment.
  
  
  METHODS
  A prospective, observational, descriptive study was undertaken in 15 patients with chronic hand eczema that was refractory to treatment with potent topical corticosteroids. Patients were administered oral alitretinoin 30 mg/d for 3 months followed by 6 months of follow-up.
  
  
  RESULTS
  A complete response, with "clear" hands was obtained in 7 patients (47%), 5 patients (33%) achieved a partial response (almost clear hands), 1 patient (7%) showed substantial improvement, 1 (7%) showed moderate improvement, and 1 patient (7%) did not respond to treatment. Relapse occurred within 6 months of treatment suspension in 54% of cases. The treatment was well tolerated. Side effects, observed in 50% of cases, were mild (headache, elevated lipid levels, slightly elevated transaminase levels, and epigastric pain), except in 1 patient, who had a substantial reduction in thyroid stimulating hormone levels.
  
  
  CONCLUSIONS
  The results of our study support the proposal of alitretinoin as an effective and safe short-term and medium-term treatment for chronic hand eczema in patients whose disease is refractory to treatment with potent topical corticosteroids.
authors.affiliation: Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. ingridaguayo77@hotmail.com
authors.forename: I R
authors.initials: IR
authors.lastname: Aguayo-Leiva
authors.forename: S
authors.initials: S
authors.lastname: Urrutia
authors.forename: P
authors.initials: P
authors.lastname: Jaén-Olasolo
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000077556:Alitretinoin; D002648:Child; D002908:Chronic Disease; D004351:Drug Resistance; D004485:Eczema / Q000188:drug therapy*; D005260:Female; D006229:Hand Dermatoses / Q000188:drug therapy*; D006261:Headache / Q000139:chemically induced; D006801:Humans; D006937:Hypercholesterolemia / Q000139:chemically induced; D008875:Middle Aged; D009784:Occupational Diseases / Q000188:drug therapy; D011446:Prospective Studies; D013972:Thyrotropin / Q000172:deficiency; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D000077556:Alitretinoin; D014212:Tretinoin; D013972:Thyrotropin