Systemic treatment of hand eczema

Research output: Contribution to journalMeeting AbstractAcademic

Abstract

Alitretinoin (9-cis-retinoic acid) is the only drug licensed for the treatment of severe chronic hand eczema in adults. Alitretinoin is strongly recommended as second line treatment for severe chronic hand eczema refractory to topical steroids according to the European guidelines on the diagnosis, prevention and treatment of hand eczema. The strong evidence is based on placebo-controlled trials, the comparative advantage over other systemic treatments needs further evaluation. Alitretinoin is more effective in the hyperkeratotic subtype of hand eczema than in recurrent vesicular hand eczema. Cyclosporine is licensed to treat atopic dermatitis and is used off-label for the treatment of severe chronic hand eczema. The evidence for cyclosporine in the treatment of hand eczema is scarce, only one RCT has been done. A daily practice study showed that cyclosporine is a treatment option to be considered in patients with recurrent vesicular hand eczema. Azathioprine and methotrexate are also used off-label to treat hand eczema in daily practice and may be considered if first and second line therapy has been insufficient or contra-indicated. Dupilumab is a monoclonal antibody inhibiting interleukin (IL) 4 and IL-13 signalling. It has been registered for the treatment of moderate to severe atopic dermatitis and has now become widely available. Hand eczema is common in patients with atopic dermatitis. In an observational prospective open label study we aim to evaluate the effectiveness of dupilumab on atopic hand eczema in patients treated for atopic dermatitis. The main study outcomes are response to treatment, measured with a Physician Global Assessment using the Photograpic guide and severity of hand eczema with the Hand Eczema Severity Index (HECSI). Enrolment started as of January 2018. The results of an interim analysis after 16 weeks of treatment with dupilumab will be presented.
Original languageEnglish
Pages (from-to)27
Number of pages1
JournalCONTACT DERMATITIS
Volume79
Issue numberSuppl.1
DOIs
Publication statusPublished - 1-Oct-2018
Event14th Congress of the European Society of Contact Dermatitis (ESCD), 18–20 October 2018, Milan, Italy - Milan, Italy
Duration: 17-Oct-201820-Oct-2018
Conference number: 14

Keywords

  • alitretinoin
  • azathioprine
  • cyclosporine
  • dupilumab
  • endogenous compound
  • interleukin 13
  • interleukin 4
  • methotrexate
  • placebo
  • steroid
  • adult
  • atopic dermatitis
  • comparative effectiveness
  • conference abstract
  • controlled study
  • diagnosis
  • drug therapy
  • female
  • hand eczema
  • human
  • hyperkeratosis
  • male
  • off label drug use
  • open study
  • physician
  • practice guideline
  • prospective study
  • signal transduction
  • systemic therapy
  • topical drug administration
  • treatment response

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