Clinical response of chronic hand dermatosis to oral alitretinoin is dictated by clinical lesion morphology rather than etiology

Abstract

Background: Previous studies have demonstrated efficacy and safety of oral alitretinoin in chronic hand eczema (CHE). Meanwhile, palmoplantar pustulosis (PPP) can be difficult to distinguish from CHE, and efficacy of alitretinoin in PPP is still controversial. Objective: To assess the efficacy and safety of oral alitretinoin in chronic hand dermatosis Methods: Total 46 patients with chronic hand dermatosis including CHE and PPP were analyzed retrospectively for efficacy of oral alitretinoin depending on the morphologic (hyperkeratotic, vesicular, and fingertip) and etiologic (CHE and PPP) classification. Results: When total patients were divided according to morphology, there was no significant difference in efficacy of alitretinoin between hyperkeratotic and fingertip subtypes (p=1.000), and hyperkeratotic and fingertip subtypes showed higher efficacy than vesicular subtype, with response rates of 75.8%, 86.7%, and 47.1%, respectively. When divided according to etiology, there was no significant difference in efficacy between CHE and PPP (p=0.329). There were no serious side effects, and flushing (10.9%) and headache (8.7%) were the most common. Limitations: Retrospective nature of the study Conclusion: Efficacy of alitretinoin in chronic hand dermatosis is better in hyperkeratotic and fingertip subtypes than in vesicular subtype. When predicting the efficacy of alitretinoin in chronic hand dermatosis, it seems more reasonable to predict the efficacy based on morphology, not etiology.