Alitretinoin is recommended as a possible treatment for people with severe chronic hand eczema if:
- their eczema has not improved with treatments called potent topical corticosteroids and
- standard assessments show that their eczema is severe and is affecting their quality of life.
Alitretinoin treatment should be stopped:
- as soon as the eczema has clearly improved or
- if the eczema remains severe after 12 weeks or
- if the eczema has not clearly improved after 24 weeks.
Treatment with alitretinoin should be started and monitored only by doctors who:
- are skin specialists (dermatologists) or
- have experience in both treating people with severe chronic hand eczema and using drugs like alitretinoin.
When assessing how a person’s eczema affects their quality of life, healthcare professionals should take into account any disabilities or difficulties in communicating which might mean that the standard assessments do not provide accurate information.
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.