title: Treatment of severe, chronic hand eczema: results from a UK-wide survey.
abstract: Treatment of severe hand eczema (HE) that is resistant to topical potent corticosteroid treatment is challenging. In 2013, we surveyed 194 UK dermatologists to obtain information about their usual treatment pathways to inform the choice of the comparator in a trial of alitretinoin in severe HE (ALPHA trial); the results indicated that the treatment approaches favoured by UK dermatologists differ. Psoralen combined with ultraviolet A (PUVA) and alitretinoin were identified as the most frequent first-line treatment options for hyperkeratotic HE, whereas oral corticosteroids were identified as the most frequent first-line treatment for vesicular HE, followed by PUVA and alitretinoin. In terms of potential adverse effects of long-term or repeated use, oral steroids and ciclosporin A were reported to cause most concern. There is uncertainty about which treatment gives the best short and long-term outcomes, because of a lack of definitive randomised controlled trials evaluating the effectiveness of different treatment pathways in severe HE.
authors.affiliation: Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK.
authors.forename: I L
authors.initials: IL
authors.lastname: Smith
authors.affiliation: Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK.
authors.forename: S
authors.initials: S
authors.lastname: Brown
authors.affiliation: Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK.
authors.forename: J
authors.initials: J
authors.lastname: Nixon
authors.affiliation: Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK.
authors.forename: F C
authors.initials: FC
authors.lastname: Cowdell
authors.affiliation: School of Healthcare, University of Leeds, Leeds, Yorkshire, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ersser
authors.affiliation: Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, Yorkshire, UK.
authors.forename: C
authors.initials: C
authors.lastname: Fernandez
authors.affiliation: Department of Dermatology, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, Yorkshire, UK.
authors.forename: M
authors.initials: M
authors.lastname: Goodfield
authors.affiliation: Department of Dermatology, Ninewells Hospital, Dundee, Tayside, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Green
authors.affiliation: Department of Dermatology, Newcastle Hospitals, Newcastle, Tyne and Wear, UK.
authors.forename: P
authors.initials: P
authors.lastname: Hampton
authors.affiliation: Department of Dermatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
authors.forename: J T
authors.initials: JT
authors.lastname: Lear
authors.affiliation: St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: C H
authors.initials: CH
authors.lastname: Smith
authors.affiliation: Street Lane Practice, Leeds, Yorkshire, UK.
authors.forename: L
authors.initials: L
authors.lastname: Sunderland
authors.affiliation: Academic Unit of Health Economics, University of Leeds, Leeds, Yorkshire, UK.
authors.forename: S
authors.initials: S
authors.lastname: Tubeuf
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, Yorkshire, UK.|NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, Yorkshire, UK.|Department of Dermatology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, Yorkshire, UK.
authors.forename: M
authors.initials: M
authors.lastname: Wittmann
mesh_terms: D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000077556:Alitretinoin; D002908:Chronic Disease; D000072085:Dermatologists; D004485:Eczema / Q000188:drug therapy*; D006229:Hand Dermatoses / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D007641:Keratolytic Agents / Q000627:therapeutic use*; D011701:PUVA Therapy / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D014212:Tretinoin / Q000627:therapeutic use*; D006113:United Kingdom
chemical_list: D000305:Adrenal Cortex Hormones; D007641:Keratolytic Agents; D000077556:Alitretinoin; D014212:Tretinoin