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Pompholyx — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardInflammatory DermatosesPompholyxSCE Dermatology

A patient taking alitretinoin for severe chronic hand eczema remains rated severe on the physician global assessment after 12 continuous weeks despite adherence. DLQI has improved from 19 to 12. What does NICE TA177 require?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Stop alitretinoin because disease remains severe at week 12

Explanation lettering: E = shown as A · D = shown as C · A = shown as D · C = shown as E

E is correct. NICE TA177 specifies stopping alitretinoin if severe disease persists at 12 weeks. Treatment also stops as soon as hands are clear or almost clear, or if that response has not been achieved by 24 weeks. A DLQI improvement does not override the week-12 physician global-assessment rule. The licensed starting dose is generally 30 mg daily, with reduction to 10 mg for tolerability rather than escalation above 30 mg. Before selecting another systemic treatment, the clinician should reconsider contact allergy, irritant exposure, infection, adherence and phenotype as well as retinoid safety.

Reference: NICE TA177: alitretinoin for severe chronic hand eczema: https://www.nice.org.uk/guidance/ta177/chapter/1-Recommendations