title: Immunomodulation in patients with chronic hand eczema treated with oral alitretinoin.
abstract: BACKGROUND
  Oral alitretinoin (9-cis-retinoic acid; 9-cis-RA) has shown clinical efficacy in patients with chronic hand eczema (CHE). Herein, we investigated the impact of oral 9-cis-RA on the local and systemic immune response in patients with CHE.
  
  
  METHODS
  Twenty patients with CHE were treated with oral alitretinoin (10 or 30 mg/day) for at least 24 weeks. Blood samples were taken for flow cytometry, and serum samples were assessed by ELISA to determine immunoglobulin (Ig) levels. Skin biopsies from lesional skin were evaluated immunohistochemically.
  
  
  RESULTS
  Upon 9-cis-RA treatment, improvement of the CHE was observed in all patients. A significant decrease in plasmablasts in the peripheral blood and a significant reduction of serum IgE levels were determined. Furthermore, we detected a significant reduction of CD4+ cells and regulatory T cells in the peripheral blood upon treatment. By contrast, these cell subsets were significantly increased in the affected skin. Cytokine analysis of activated CD154-positive T cells showed a reduction of interleukin (IL)-17 but not of IL-4 or IFN-γ production.
  
  
  CONCLUSIONS
  Overall, our data indicate a disease-modifying effect of 9-cis-RA, including a systemic decrease in IL-17-positive cells, but decreased serum IgE and CD23 expression. The increased frequency of FoxP3-positive cells in the skin upon treatment may suggest a mechanism by which hand eczema is therapeutically targeted by 9-cis-RA, but this will need to be proven in the future studies.
authors.affiliation: Allergy Center Charité, Department of Dermatology and Allergology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Mandana
authors.initials: M
authors.lastname: Schindler
authors.forename: Gennadiy
authors.initials: G
authors.lastname: Drozdenko
authors.forename: Anja Andrea
authors.initials: AA
authors.lastname: Kühl
authors.forename: Margitta
authors.initials: M
authors.lastname: Worm
mesh_terms: D000328:Adult; D000368:Aged; D000077556:Alitretinoin; D015496:CD4-Positive T-Lymphocytes / Q000187:drug effects / Q000276:immunology; D002908:Chronic Disease; D016207:Cytokines / Q000097:blood; D004485:Eczema / Q000097:blood / Q000188:drug therapy* / Q000276:immunology*; D005260:Female; D005434:Flow Cytometry; D006225:Hand; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007150:Immunohistochemistry; D007155:Immunologic Factors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D050378:T-Lymphocytes, Regulatory / Q000187:drug effects / Q000276:immunology; D014212:Tretinoin / Q000008:administration & dosage*
chemical_list: D016207:Cytokines; D007155:Immunologic Factors; D000077556:Alitretinoin; D007073:Immunoglobulin E; D014212:Tretinoin