A nationwide randomised controlled trial is currently comparing the retinoid alitretinoin and PUVA. Since 2015, 35 hospitals across the country have been recruiting adults with severe hand eczema that is not responding to potent topical steroids for the ALPHA (ALitretinoin versus PUVA in severe chronic HAnd eczema) trial.13

Between 500 and 780 patients on the trial will be randomised to receive either alitretinoin 30mg daily, or to have immersion PUVA treatment twice weekly for 12 weeks. This will be in conjunction with concomitant topical corticosteroids, emollients and patient education.

Alitretinoin can cause headaches and increase cholesterol levels, and less common side effects include skin or eye dryness, so dermatologists should regularly monitor patients. As alitretinoin is teratogenic, it is contraindicated in women of childbearing potential unless they follow all the conditions of the Pregnancy Prevention Programme.13,17,20

Sunburn is the main concern with PUVA, but the UV light dosage can be reduced accordingly. Long term considerations include an increased risk of skin cancer if PUVA is used regularly over many years.