Recommendation: long-term therapy of occupational hand eczema with alitretinoin within therapies of the employer's liability insurance association

Abstract

Introduction: Alitretinoin is currently the only systemic medication approved for the treatment of hand eczema (HE). In practice, questions often arose regarding medical indication and evidence-based use of alitretinoin treatment with a special focus on exceeding the intended period of time (6 months) set out in the authorization for the drug. Those elongated treatment periods then become off-label use. Methods: Analysis of the available scientific literature relating to systemic treatment of HE with alitretinoin with regard to the medical indication and a standards-compliant use as well as a discussion of case constellations and aspects which need to be taken into consideration concerning a long-term therapy (> 6 months) of occupational HE with alitretinoin. Results: Currently, the data situation regarding longterm therapy has to be described as incomplete. Evidence-based therapy is therefore currently not possible. Nine case constellations and aspects for off-label therapy are discussed in each individual case. Discussion: A detailed consideration of individual case constellations - whilst taking an evaluation of the concomitant circumstances into account - is indispensable in order to develop scientifically justified recommendations for action regarding long-term therapy of occupational HE with alitretinoin. Perspectively, further clinical studies - in particular case-control studies - are needed to close evidence gaps and gather information on potential side effects. To prepare such a study, retrospective or prospective casuistries should be worked up. Conclusion: The case constellations, which have been explored from a medical and scientific point of view in the present study, can supportingly be embedded into future decision-making processes in practice.