Methotrexate versus Acitretin in the Treatment of Chronic Hand Dermatitis

Recent studies have produced treatment algorithms for hand dermatitis, but there are limited current indications of systemic treatments for chronic hand dermatitis.

To compare the efficacy and safety of methotrexate and acitretin in the treatment of chronic hand dermatitis.

A chart-retrospective review of all patients with hand dermatitis seen by the primary author at the University of North Carolina Dermatology and Skin Cancer Center from September 2007 to April 2013.

Eighty-three hand dermatitis charts were reviewed. Twenty-nine patients received systemic therapy, of which 17 (26.5%) were treated systemically with acitretin and/or methotrexate. Of these 17 patients, four patients received courses of both acitretin and methotrexate independently after failing the alternative treatment course. At 6 months, acitretin achieved clearance/almost clearance in 44% of patients, compared to 0% of those treated with methotrexate. At 12 months, 100% of patients treated with acitretin achieved clearance/almost clearance compared to 40% of patients treated with methotrexate. Adverse effects were minimal and as expected.

This was a retrospective study, and the small sample size makes it difficult to generalize results.

Systemic retinoids are a good alternative for the treatment of chronic hand dermatitis.