Treatment of chronic hand dermatitis with alitretinoin: a dermatology practice update

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Erika Crowley

Abstract




Chronic hand dermatitis (CHD) patients have responded well to alitretinoin in controlled clinical trials. In 2013, a community dermatology practice chart review demonstrated that alitretinoin was a safe and well- tolerated treatment in real-world practice. This review provides an update on this practice cohort. This retrospective chart review includes all CHD patients at a Dermatologist’s office in Ontario, prescribed at least one dose of alitretinoin from November 2010 until August 2013 and follows their treatment course until January 1, 2017. Participants were prescribed a daily oral dose of alitretinoin and laboratory assessments were conducted every 2 months. The average age was 57.3 ± 12.2 years and 60.0% were male. Of the 80 CHD patients prescribed alitretinoin, 25 (31.3%) did not take alitretinoin due to concern over side effects, the co-pay, lack of insurance or reason not specified. Currently, 13 (23.6%) participants remain on long-term therapy with good control of their disease. Of the participants to take alitretinoin, the median time on treatment was 10 months and the ongoing maximum is 71 months. Further, 60% of participants who stopped therapy did so within the first year. The most common reasons to discontinue therapy or decrease dose were clearance of disease or side effects. Sixteen (29.0%) patients who discontinued therapy had to restart therapy because of moderate-to-severe flare-ups. The most common adverse events (AEs) were headaches, nausea, joint pain/stiffness, hair loss/thinning and sun sensitivity. Less common AEs included depression, elevated triglycerides or cholesterol, blurred vision, hand numbness and edema. Four (7.3%) patients stopped alitretinoin due to abnormal lab values, including 1 (1.8%) with elevated triglycerides and 3 (5.5%) with elevated transaminases. Despite improvement in lab values upon discontinuation, all 4 patients’ disease flared. Alitretinoin is a safe and effective treatment option for CHD in the clinic setting with only the minority of patients requiring long-term therapy.




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Author Biography

Erika Crowley, OC

Erika Crowley is currently a Master’s Candidate in the Environmental and Life Sciences Program, using nuclear magnetic resonance spectroscopy to determine the structure of cytochrome b5 in the parasite Giardia lamblia. Erika also does research in clinical dermatology, specifically exploring treatment options for patients with hidradenitis suppurativa, chronic hand dermatitis, atopic dermatitis, palmoplantar pustulosis, alopecia areata, and other skin conditions. Erika completed her undergraduate Honours degree at Trent University in Biochemistry and Molecular Biology, with Specialization in Health Science. Her undergraduate thesis in the Inorganic Material Science Laboratory focused on the synthesis and characterization of Santa Barbara-15 silica polymers with cross-linked enzyme aggregates to retain native properties of enzymes when in unfavourable environments. Erika has had leadership roles in several clubs, including the Trent Pre-Medical Society, Chemistry Society, and Biology Society. Other commitments include the Trent Graduate Student Association, Journal of Multidisciplinary Research at Trent, Journal of Undergraduate Studies at Trent, Symons Seminar Series, Research Ethics Committee, Biology Curriculum Committee, and quadriplegic care. In her spare time, Erika volunteers at the Salvation Army to provide a free breakfast to the Peterborough community and at the Peterborough Regional Hospital to help patients achieve cardiac rehabilitation. Erika plans to pursue a MD/PhD after her Master’s degree.