Thybaut, R. (Raisa) (2014) The effects of Systemic Therapy in Hand Eczema. thesis, Medicine.
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Abstract
Background: Hand eczema is a condition with a high psychosocial burden. It is characterized by erythema, itching of the hands, infiltration of the skin, edema, vesicles, hyperkeratosis, fissures and erosions. In a number of patients the disease becomes chronic and resistant to topical therapy. In those patients systemic therapy is often started to manage the hand eczema. No guidelines are currently available for the management of hand eczema with systemic therapy and there are few studies on the effect of systemic therapy for hand eczema. Systemic therapies consists of acitretin, cyclosporin A, methotrexate, azathioprine, mycophenolic acid sodium and mycophenolate mofetil, alitretinoin and maintenance use of prednisolone. The aim of this study is to identify the systemic therapies, which are used in daily practice for hand eczema. Also, we would like to identify the adverse events of these therapies and the influence of patient characteristics on the effects of the therapy. Methods: Patients who used systemic therapy for hand eczema in the UMCG were included from January 1994 until December 2013. Data was recorded in a newly developed Access database, which contained characteristics such as: patient characteristics, start/stop date, reasons for stopping, effectiveness, adverse events, lab results, blood pressure, co-medication and atopic characteristics. Alitretinoin has only been available on the Dutch market for a few months and was therefore not included in analysis of this study. Results: A total of 161 patients were included, of whom 141 patients used one or more systemic therapies (mean age 49.5 years). Acitretin was the most used therapy with 110 treatment episodes and had a good effect in 67.2% of the patients, with a median duration of 154 days in the first treatment episode. The most common adverse event was dry skin and mucosa (35.4%). Cyclosporin had 77 treatment episodes and had a good effect in 77.4% of the patients, with a median duration of 228 days in the first treatment episode. Patients with atopic characteristics and atopic dermatitis specifically, reported a significantly better response to the therapy. Methotrexate and azathoprine had 28 and 27 treatment episodes, respectively. Both therapies had a good effect in 50% of the patients, with a median duration of 157 days for methotrexate and 252 days for azathioprine. Mycophenolic acid sodium and mycophenolate mofetil contained too few patients to draw conclusions from. The most common stop reasons in all therapies were adverse events and non-responsiveness. Adverse events mainly consisted of gastrointestinal symptoms, head ache and fatigue. A higher blood pressure at the start of therapy and a higher start value of triglycerids lead to higher top values and stop reasons in cyclosporin and acitretin, respectively. Conclusion: Over the past 20 years acitretin was the most used systemic therapy for hand eczema, but cyclosporin showed the best effectiveness. Patients with atopic characteristics seemed to have the best response with cyclosporin. Adverse events were gastrointestinal symptoms, head ache and fatigue, among others.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Schuttelaar, dr. M.L.A. and Christoffers, drs. W.A. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:55 |
| Last Modified: | 25 Jun 2020 10:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1552 |
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