Hand eczema is a common condition which can have far-reaching personal, psychological and occupational consequences. The long-term prognosis of hand eczema is poor, especially in patients with a long history.
According to the European guideline for diagnosis, prevention and treatment of hand eczema topical corticosteroids and emollients (possibly supplemented by UV-irradiation) are strongly recommended for first line treatment. In an estimated 2-4% of the hand eczema patients topical treatment fails. The recommended secondary treatment option for these severe cases is alitretinoin.
Alitretinoin is the only registered systemic treatment option for all clinical subtypes of severe chronic hand eczema, refractory to topical steroids, and it has shown to be effective in large randomized controlled trials. However, different clinical subtypes have a variable rate of response to treatment. In a large trial, 54% of patients with hyperkeratotic hand eczema reached clearance or almost clearance. For vesicular hand eczema this was only 33%.
In our clinical experience cyclosporine has a favorable effect on hand eczema, especially in the vesicular subforms. This was supported by both a retrospective study of cyclosporine in our center as well as a few small studies in the literature.
The primairy aim of this study is to compare the efficacy of alitretinoin and cyclosporine in patients with severe vesicular hand eczema after 24 weeks. Furthermore health related quality of life, improvement in severity assessed by the patient, time to response, adverse events, cost-utility and cost-effectiveness will be analysed.