Technology Appraisal Guidance No. 177
Source: National Institute for Health and Care Excellence
1.1 Alitretinoin is recommended, within its licensed indication, as a treatment option for adults with severe chronic hand eczema that has not responded to potent topical corticosteroids if the person has:
- severe disease, as defined by the physician's global assessment (PGA) and
- a dermatology life quality index (DLQI) score of 15 or more.
1.2 Alitretinoin treatment should be stopped:
- as soon as an adequate response (hands clear or almost clear) has been achieved or
- if the eczema remains severe (as defined by the PGA) at 12 weeks or
- if an adequate response (hands clear or almost clear) has not been achieved by 24 weeks.
1.3 Only dermatologists, or physicians with experience in both managing severe chronic hand eczema and the use of systemic retinoids, should start and monitor treatment with alitretinoin.
1.4 When using the DLQI, healthcare professionals should take into account any physical, sensory or learning disabilities, or other communication difficulties that could affect the responses to the DLQI. In such cases, healthcare professionals should ensure that the DLQI continues to be a sufficiently accurate measure.
The guidance shown above constitutes Section 1 of the full document. A copy of the full document and a summary of the evidence is available on the Internet at
An abridged version of this guidance (a 'quick reference guide') is also available. Printed copies of the quick reference guide can be obtained by ing 0845 003 7783 or emailing and quoting reference number N1981. It is also available on the Internet at
This guidance represents the view of the Institute which was arrived at after careful consideration of the available evidence. Health professionals are expected to fully take it into account when exercising their clinical judgement. This guidance does not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
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Enquiries concerning the guidance should be addressed to: National Institute for Health and Care Excellence, MidCity Place, 71 High Holborn, London WC1V 6NA. email:
Alitretinoin for the treatment of severe chronic hand eczema.
Issue Date: August 2009
Review Date: August 2012