Abstract

Alitretinoin, a vitamin A derivative, is used as a systemic option for severe chronic hand eczema (CHE) that does not respond adequately to topical therapies. Prior evidence suggests it can lead to substantial lesion clearance in roughly half of treated patients, but its use may be limited by adverse effects such as headache and changes in lipid profiles. This systematic review and meta-analysis re-examined the overall efficacy and safety of alitretinoin in CHE using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided approach. PubMed, Web of Science, and Scopus were searched for relevant studies evaluating ali tretinoin in CHE. Eligible studies were screened, assessed for risk of bias, and pooled using random-effects meta-analysis in R. From 464 identified records, 10 studies encompassing 2,831 patients met inclusion criteria. Pooled results indicated that 60.7% of patients achieved “clear” or “almost clear” disease according to the Physician Global Assessment after alitretinoin treatment. Adverse events were reported in 8.4% of patients, with headache and dry skin being the most common. Treatment discontinuation due to side effects occurred in 8.0% of patients. Between-study heterogeneity was high for both efficacy and adverse event rates, suggesting variability in treatment response and reporting across studies, while variation was low for discontinuation rates, implying more consistent findings regarding safety-related withdrawal. Overall, alitretinoin appears to be an effective and relatively well-tolerated systemic therapy for CHE, providing meaningful clinical improvement for many patients and remaining a practical option when standard treatments fail.

Key words: Alitretinoin, chronic hand eczema, review