Open-label exploratory study of acitretin for the treatment of severe chronic hand dermatitis.

Introduction: Acitretin is a retinoid approved for the treatment of psoriasis that has good efficacy for palmoplantar psoriasis. The safety and efficacy of acitretin in severe chronic hand dermatitis (CHD) is unknown.

Methods: A total of nine patients with severe CHD were enrolled and treated with acitretin 10 mg once daily which could be increased to 30 mg daily if well-tolerated. Patients were treated for up to 24 or 12 weeks if the physician global assessment (PGA) was clear or almost clear at that time. CHD severity was evaluated using a 5-grade PGA scale and the modified total lesion symptom score (mTLSS).

Results: The proportion of patients achieving PGA of clear or almost clear was 33.3% (95% CI: 9-69%) and the proportion achieving PGA of clear, almost clear or mild was 44% (95% CI: 15-77%). The mTLSS decreased by 45% (-6.3 ± 4.7; p = 0.02). Three patients did not complete the study: one due to an increase in facial dermatitis, one due to lack of efficacy and one who withdrew consent.

Conclusions: This pilot study suggests that acitretin could improve severe CHD. Further studies are needed to better assess the efficacy and safety of acitretin in patients with severe CHD.