Immunosuppressants

Alitretinoin (known as Toctino) is an oral treatment for adults with severe eczema who have not responded to potent topical steroids. Alitretinoin works by reducing the inflammation associated with eczema as well as damping down the response of the immune system. It’s a capsule that is taken by mouth once a day with a meal for 12-24 weeks, depending on how the condition responds to the treatment.  

• Alitretinoin can only be prescribed by dermatologists or doctors with experience in managing severe hand eczema and retinoids. The specialist will determine whether your hand eczema is severe by examining your hands and asking questions about how the eczema affects your life. You will need to be carefully monitored.  

• Retinoids are likely to cause severe birth defects if taken during pregnancy. This means that anyone with childbearing potential must avoid becoming pregnant during treatment and for one month after stopping treatment – for example, by using two effective methods of contraception. The drug can only be prescribed if a pregnancy test is negative. Regular pregnancy tests will be taken during treatment.  

• You should not breastfeed while taking alitretinoin and for a month after completing treatment.  

• The most common side effects are headaches, dry lips and skin, and flushing. Other side effects include raised blood fats such as cholesterol, and decreased levels of thyroid hormone. Due to potential side effects, a lower dose will be prescribed if you are diabetic.