alitretinoin (Alitoc / BAL 4079 / BAL4079)

Evaluation of delgocitinib for the treatment of moderate to severe chronic hand eczema in adults.

Piaskowski Nicole N, Globig Philipp P, Worm Margitta M

Chronic hand eczema (CHE) is a frequent inflammatory skin disorder associated with a substantial psychosocial and economic burden. Its prevalence ranges from 4.7% up to 10%. The therapeutic management of CHE remains challenging. Long-term use of topical corticosteroids, which are used as first-line therapy, can be associated with local side effects and a negative impact on the skin barrier. Alitretinoin, a vitamin A derivate licensed as a systemic treatment option in Europe, has demonstrated efficacy but is accompanied by systemic adverse effects. Delgocitinib is a novel topical anti-inflammatory pan-janus kinase inhibitor with negligible systemic exposure and a reduced risk of side effects. It has shown clinical efficacy in double blind placebo-controlled trials and most recently superiority against alitretinoin in terms of both, efficacy and safety. This review summarizes the data on delgocitinib as a topical treatment for CHE including pharmacokinetics, pharmacodynamics, efficacy and safety. Delgocitinib is a topical pan-janus kinase (JAK) inhibitor and represents a novel treatment option for CHE with a favorable safety and tolerability profile. Further data on long-term use and real-world effectiveness are still needed.

Efficacy of oral alitretinoin for concomitant foot eczema in chronic hand eczema.

Cha Soobin S, Lee Jungsoo J, Shin Kihyuk K, Kim Hoon-Soo HS et al.

The Clinical Efficacy and Mechanism of Action of Alitretinoin in the Treatment of Alopecia Areata.

Shin Jung-Min JM, Go Bogyeong B, Seo Young-Joon YJ, Kim Chang Deok CD et al.

Alitretinoin, a pan-retinoid receptor agonist approved for chronic hand eczema, exhibits immunomodulatory effects that may benefit alopecia areata (AA). However, clinical evidence for its use in AA is limited. To evaluate alitretinoin's clinical efficacy and immunological mechanism in patients with AA. We reviewed retrospectively twenty-one patients with AA who were treated with alitretinoin, either as monotherapy (n=9) or add-on therapy (n=12). Treatment response was assessed using the Severity of Alopecia Tool (SALT) scores, and in vitro studies used human outer root sheath cells stimulated with interferon-γ and polyinosinic:polycytidylic acid to investigate the drug's effects on inflammatory pathways. Both groups showed significant reductions in SALT scores (p=0.04 and p=0.02, respectively). Patients with baseline SALT scores below 50 demonstrated superior improvement. Adverse events were mild, with headache (33.3%) and cheilitis (4.8%) being the most common. In vitro, alitretinoin suppressed interleukin-6 and tumor necrosis factor-α expression, decreased phosphorylation of signal transducer and activator of transcription (STAT) 1/STAT3, and downregulated major histocompatibility complex class I expression, suggesting restoration of hair follicle immune privilege. Alitretinoin appears to be a safe and potentially effective treatment for patients with mild to moderate AA unresponsive to conventional therapies. Its role as a monotherapy or adjunctive option in selected cases warrants further investigation through larger controlled studies.

A Retrospective Real-World Comparison of Topical Delgocitinib and Localized Cream Psoralen-Ultraviolet A in Chronic Hand Eczema.

Weißinger Stefan S, Oppel Eva E, Kurzen Nils N, Ertl Carolin C et al.

Chronic hand eczema (CHE) remains difficult to treat, particularly in patients unresponsive or intolerant to topical corticosteroids. Although topical delgocitinib, the first topical JAK inhibitor approved for CHE, provides a steroid-free alternative, comparative real-world data versus localized cream psoralen-ultraviolet A (PUVA) are missing. This retrospective real-world study compared the short-term effectiveness and patient-reported outcomes of topical delgocitinib and localized cream PUVA in patients with CHE under routine-care conditions. This retrospective cohort study analyzed anonymized routine-care data of patients with moderate-to-severe CHE treated between 2024 and 2025 at a tertiary center. Patients received topical delgocitinib twice daily or localized cream PUVA with as-needed topical corticosteroids (TCS). Twenty-two patients per group completed 12 weeks of delgocitinib or 20-25 PUVA sessions plus TCS (per-protocol). Disease severity (Physician's Global Assessment, PGA), quality of life (Dermatology Life Quality Index, DLQI), and symptom numerical rating scales (pruritus, pain, sleep disturbance) were assessed at baseline and treatment end. Both therapies significantly improved all endpoints (p < 0.001). Median DLQI improvement was 10 with delgocitinib versus 7.5 with PUVA (p = 0.15). PGA 0/1 responses were 82% vs 73% (p = 0.72). DLQI improvement ≥ 4 points occurred in 91% vs 77% (p = 0.41). Relapses were more frequent after PUVA. Two delgocitinib non-responders improved with alitretinoin. Most delgocitinib responders continued proactive low-frequency use to maintain remission; one remained clear 3 months after stopping treatment. Delgocitinib and PUVA provided comparable short-term clinical efficacy in CHE, with a numerically greater DLQI reduction for delgocitinib. Proactive delgocitinib maintenance may help sustain disease control. Subtype-adapted treatment strategies could further optimize outcomes.