title: Alitretinoin and acitretin in severe chronic hand eczema; results from a retrospective daily practice study.
abstract: Acitretin has been used off-label for years to treat chronic hand eczema, but acitretin is less often prescribed as alitretinoïne was approved. This study evaluates both retinoids in a daily practice cohort of patients with severe chronic hand eczema in terms of drug survival and reasons for discontinuation. Patients using alitretinoin or acitretin between 01-01-1994 and 01-08-2015 were included in this retrospective daily practice study and analyzed by Kaplan-Meier drug survival curves. Potential determinants were analyzed by Cox regression analyses. Ninety-five patients were treated with alitretinoin and 109 patients with acitretin. The main reasons for discontinuation were adverse events and cleared hand eczema, 29.5 and 27.4% in alitretinoin versus 43.1 and 23.9% in acitretin. Patients with hyperkeratotic hand eczema had most often a good effect of treatment: 68.3% in alitretinoin and 50.7% in acitretin treatment. The drug survival rates of alitretinoin and acitretin after 12, 24, 36, and 52 weeks were 69.3, 45.1, 19.6, 7.0% and 74.3, 45.5, 33.8, 23.2%, respectively. Alitretinoin and acitretin are effective treatment options for patients with hand eczema. However, both treatments were more effective in patients with hyperkeratotic hand eczema. Fewer patients discontinued alitretinoin compared with acitretin due to adverse events.
authors.affiliation: Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Klaziena
authors.initials: K
authors.lastname: Politiek
authors.affiliation: Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Wietske Andrea
authors.initials: WA
authors.lastname: Christoffers
authors.affiliation: Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Pieter-Jan
authors.initials: PJ
authors.lastname: Coenraads
authors.affiliation: Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. m.l.a.schuttelaar@umcg.nl.
authors.forename: Marie-Louise Anna
authors.initials: MA
authors.lastname: Schuttelaar
mesh_terms: D017255:Acitretin / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000077556:Alitretinoin; D002908:Chronic Disease; D003879:Dermatologic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004485:Eczema / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006229:Hand Dermatoses / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007642:Keratosis / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012074:Remission Induction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D003879:Dermatologic Agents; D000077556:Alitretinoin; D014212:Tretinoin; D017255:Acitretin
keywords: acitretin; alitretinoin; daily practice; drug survival; hand eczema