Alitretinoin

How it works

As a vitamin A derivative it binds both retinoic acid and retinoid X receptors, modulating inflammation and keratinocyte activity in the skin.

Prescribing in practice

• It is teratogenic and contraindicated in pregnancy, requiring reliable contraception and pregnancy testing under a pregnancy prevention approach in those who can become pregnant.
• It can raise serum lipids and thyroid-related parameters and affect liver function, so these should be checked before and during treatment.
• Treatment is usually initiated by a specialist and stopped if there is inadequate response after an adequate course.

Monitoring

Monitor lipids, liver and thyroid function, with pregnancy testing where applicable, before and during treatment.

Counselling the patient

• Effective contraception is essential throughout treatment and for the advised period afterwards.
• Report headache with visual disturbance, and expect dryness of skin, lips and eyes.
• Do not donate blood during and after treatment as directed.

Evidence & guidelines

NICE recommends alitretinoin as an option for severe chronic hand eczema refractory to potent topical corticosteroids, supported by the BACH trial.