We explored the effects of alitretinoin, a form of vitamin A, on chronic hand eczema (CHE). This powerful drug is known to target specific receptors in the skin, offering insights into its method of action. Through our detailed study, we examined skin samples from patients who responded well to alitretinoin treatment.
Our analysis revealed a total of 231 genes that were markedly regulated. We found that alitretinoin primarily impacts keratinocytes, the skin's primary cells, by addressing inflammation and enhancing skin barrier function. This treatment improved the expression of certain protective proteins while fostering the production of hyaluronic acid, a substance that helps hydrate and soothe the skin.
Furthermore, we observed that alitretinoin also affects immune cells, particularly dendritic cells, which play a vital role in our immune response. These cells, when treated with alitretinoin, displayed unique alterations in their appearance and function. They had lower levels of specific markers that typically spur an immune response and stimulated the production of IL-10, a cytokine that promotes immune tolerance. Most impressively, these treated cells were less effective at activating T cells, which are crucial for initiating inflammation.
Our findings indicate that alitretinoin not only treats the visible symptoms of eczema but also helps regulate the immune response, providing a dual approach in the management of chronic hand eczema. Ultimately, these insights show that vitamin A treatment holds significant promise for improving outcomes in eczema patients.
Read More
9
Alitretinoin treatment effectiveness assessed
Alitretinoin: A Review in Severe Chronic Hand Eczema.
We examined the effectiveness of alitretinoin, a vitamin A derivative, for treating severe chronic hand eczema—especially for those who haven't found relief with strong topical steroids. In clinical trials, participants took alitretinoin daily for up to 24 weeks, and results showed a notable improvement in eczema severity and extent.
Many patients reported their hands becoming 'clear' or 'almost clear,' significantly more than those using a placebo. This exciting finding was consistent in real-world studies as well. Alitretinoin generally proved to be well tolerated, with most side effects being mild, manageable, and reversible.
Overall, we see that alitretinoin stands out as a valuable option for patients struggling with chronic hand eczema that doesn't respond to traditional treatments. It gives hope to individuals who have endured pain and discomfort due to this challenging condition.
Read More
9
Alitretinoin improves chronic hand eczema
Alitretinoin for the treatment of severe chronic eczema of the hands.
We explored the therapeutic potential of alitretinoin, a form of vitamin A, for treating severe chronic hand eczema (CHE). This condition is quite prevalent, impacting up to 10% of people, and it can significantly affect their quality of life.
Alitretinoin is the first systemic treatment approved in the European Union for cases of CHE that haven't responded to conventional topical therapies. Our review highlighted various aspects, including how the drug works in the body, its effectiveness, and safety profile.
Patients who participated in clinical trials reported both objective and subjective improvements in their symptoms, along with a notable enhancement in their quality of life. However, we must exercise caution with patients who have pre-existing health issues or women who could become pregnant.
Overall, the findings suggest that alitretinoin could be a valid treatment option for those struggling with severe CHE.
Read More
Most Useful Reviews
9
Dryness reduction
10 people found this helpful
My wife has eczema and severe dryness in her hands. After using this vitamin A, her condition improved and the dryness disappeared, thank God.
Read More
9
Infection prevention
5 people found this helpful
Easy to drink size. I had eczema and itching on my skin, but after taking the supplement, the inflammation was resolved. If you don't take it, you might not get enough vitamins, and your body will itch and eczema will return. I'll keep this in mind. Great product.
Read More
9
Eczema relief
4 people found this helpful
I combined these vitamins with collagen, vitamin C, and zinc and managed to get rid of eczema. Although it’s said complete recovery isn't possible, I am very pleased!
We explored the effects of alitretinoin, a form of vitamin A, on chronic hand eczema (CHE). This powerful drug is known to target specific receptors in the skin, offering insights into its method of action. Through our detailed study, we examined skin samples from patients who responded well to alitretinoin treatment.
Our analysis revealed a total of 231 genes that were markedly regulated. We found that alitretinoin primarily impacts keratinocytes, the skin's primary cells, by addressing inflammation and enhancing skin barrier function. This treatment improved the expression of certain protective proteins while fostering the production of hyaluronic acid, a substance that helps hydrate and soothe the skin.
Furthermore, we observed that alitretinoin also affects immune cells, particularly dendritic cells, which play a vital role in our immune response. These cells, when treated with alitretinoin, displayed unique alterations in their appearance and function. They had lower levels of specific markers that typically spur an immune response and stimulated the production of IL-10, a cytokine that promotes immune tolerance. Most impressively, these treated cells were less effective at activating T cells, which are crucial for initiating inflammation.
Our findings indicate that alitretinoin not only treats the visible symptoms of eczema but also helps regulate the immune response, providing a dual approach in the management of chronic hand eczema. Ultimately, these insights show that vitamin A treatment holds significant promise for improving outcomes in eczema patients.
Read More
9
Alitretinoin improves chronic hand eczema
Alitretinoin for the treatment of severe chronic eczema of the hands.
We explored the therapeutic potential of alitretinoin, a form of vitamin A, for treating severe chronic hand eczema (CHE). This condition is quite prevalent, impacting up to 10% of people, and it can significantly affect their quality of life.
Alitretinoin is the first systemic treatment approved in the European Union for cases of CHE that haven't responded to conventional topical therapies. Our review highlighted various aspects, including how the drug works in the body, its effectiveness, and safety profile.
Patients who participated in clinical trials reported both objective and subjective improvements in their symptoms, along with a notable enhancement in their quality of life. However, we must exercise caution with patients who have pre-existing health issues or women who could become pregnant.
Overall, the findings suggest that alitretinoin could be a valid treatment option for those struggling with severe CHE.
Read More
9
Alitretinoin improves hand eczema
Effectiveness of alitretinoin in severe chronic hand eczema: PASSION, a real-world observational study.
We explored the effectiveness of oral alitretinoin, a vitamin A derivative, for treating severe chronic hand eczema (CHE). With 631 patients participating in this observational study, we administered treatment for up to 24 weeks while monitoring outcomes in real-world conditions.
Our findings were encouraging; by the end of the study, nearly 30% of participants reported significant improvements in their conditions. Utilizing assessments such as the Physician Global Assessment and the EQ-5D quality of life questionnaire, we noted a clear enhancement in patients' overall well-being and work productivity. Notably, quality of life scores increased dramatically from baseline levels, indicating relief for many who suffer from this difficult skin condition.
Moreover, workplace impairment substantially reduced over the course of the study, suggesting that alitretinoin helps not only with the physical symptoms but also allows individuals to return to their daily activities more effectively. Although some patients reported adverse effects, these were generally manageable, and no new safety concerns arose throughout the study.
In summary, we observed that alitretinoin offers significant improvements for those grappling with severe CHE, enhancing both quality of life and ability to work.
Read More
9
Alitretinoin treatment effectiveness assessed
Alitretinoin: A Review in Severe Chronic Hand Eczema.
We examined the effectiveness of alitretinoin, a vitamin A derivative, for treating severe chronic hand eczema—especially for those who haven't found relief with strong topical steroids. In clinical trials, participants took alitretinoin daily for up to 24 weeks, and results showed a notable improvement in eczema severity and extent.
Many patients reported their hands becoming 'clear' or 'almost clear,' significantly more than those using a placebo. This exciting finding was consistent in real-world studies as well. Alitretinoin generally proved to be well tolerated, with most side effects being mild, manageable, and reversible.
Overall, we see that alitretinoin stands out as a valuable option for patients struggling with chronic hand eczema that doesn't respond to traditional treatments. It gives hope to individuals who have endured pain and discomfort due to this challenging condition.
Read More
8
Vitamin A levels, eczema correlation
Changes and clinical significance of serum vitamin A, 25-(OH)D3, TG2, IL-4 and IL-13 levels in children with eczema.
We wanted to understand how vitamin A levels impact the severity of eczema in children. In our research, we analyzed clinical data from 159 children diagnosed with eczema, grouping them based on the severity of their condition—mild, moderate, and severe.
Throughout the study, we made some interesting observations. It became clear that as the severity of eczema increased, the levels of vitamin A declined significantly. We also noted a similar trend with vitamin D levels. Meanwhile, certain inflammatory markers such as TG2, IL-4, and IL-13 rose in correlation with worse symptoms.
This relationship was highlighted by our findings indicating a negative correlation between vitamin A and vitamin D levels and the severity of eczema, measured through SCORAD scores. This means as vitamin A levels dropped, the severity of eczema worsened, while increased inflammatory markers suggested intensifying symptoms.
After three months of treatment, all serum levels, including that of vitamin A, improved significantly across all groups. However, while vitamin A appears to be associated with the severity of eczema, we cannot conclude that vitamin A treatment alone effectively alleviates eczema symptoms, as no specific treatment effects were isolated during our analysis.
Overall, we believe that keeping an eye on vitamin A levels, along with these other markers, can give us valuable insights into eczema severity and treatment responses in children.
My wife has eczema and severe dryness in her hands. After using this vitamin A, her condition improved and the dryness disappeared, thank God.
Read More
9
Infection prevention
5 people found this helpful
Easy to drink size. I had eczema and itching on my skin, but after taking the supplement, the inflammation was resolved. If you don't take it, you might not get enough vitamins, and your body will itch and eczema will return. I'll keep this in mind. Great product.
Read More
9
Eczema relief
4 people found this helpful
I combined these vitamins with collagen, vitamin C, and zinc and managed to get rid of eczema. Although it’s said complete recovery isn't possible, I am very pleased!
Read More
9
Immunity support
1 people found this helpful
It helps a lot with eczema and supports immunity during colds and viruses. I take one capsule a day for 2-3 months, followed by a break.
Read More
9
Good quality ingredients
Easy to use with good quality ingredients that are beneficial for eczema.
Eczema, also known as atopic dermatitis, is a chronic skin condition characterized by inflamed, itchy, and red patches on the skin. It is most commonly seen in children but can occur at any age. The condition can range from mild to severe and often leads to dry, scaly skin that can become cracked or even bleed. Eczema is believed to be related to a combination of genetic predisposition, skin barrier dysfunction, and environmental factors, including allergens, irritants, and stress.
Treatment for eczema often involves a multi-faceted approach, including the use of moisturizers to keep the skin hydrated, topical corticosteroids to reduce inflammation, and, in some cases, antihistamines to alleviate itching. Identifying and avoiding triggers such as certain soaps, fabrics, or foods can also play a crucial role in managing the condition. While there is currently no cure for eczema, ongoing advancements in research have led to the development of new therapies, including biologic medications that target specific components of the immune response, offering hope for those with moderate to severe cases.
Vitamin A is a fat-soluble vitamin that's essential for several critical bodily functions, including vision, immune response, and cell differentiation. It comes in two primary forms: preformed vitamin A (retinol) found in animal products like liver, fish, and dairy, and provitamin A carotenoids, primarily found in colorful fruits and vegetables such as carrots, sweet potatoes, and spinach. The body can convert carotenoids into retinol, making these plant sources a valuable dietary option, especially for those following a vegetarian or vegan lifestyle.
Aside from its role in maintaining healthy vision—particularly in low-light conditions—vitamin A plays a significant role in skin health and the functioning of the heart, lungs, and kidneys. It also supports the immune system by promoting the development and function of white blood cells. While it's uncommon to experience a deficiency in countries where a balanced diet is accessible, a lack of vitamin A can lead to serious health problems, including night blindness and increased susceptibility to infections. In contrast, excessive intake of vitamin A, particularly through supplements, can be toxic and lead to several health issues, making it crucial to maintain a balanced intake.
Vitamin A plays a crucial role in skin health, and some research suggests it may be beneficial for people with eczema. Known for its ability to promote skin cell regeneration and repair, Vitamin A can contribute to maintaining the integrity of the skin barrier. A healthier skin barrier might help reduce the severity of eczema flare-ups and improve overall skin condition. However, the evidence surrounding Vitamin A's effectiveness specifically for eczema can be mixed, and results may vary from person to person.
While incorporating Vitamin A-rich foods like carrots, sweet potatoes, and leafy greens into your diet may support skin health, it's essential to approach supplementation cautiously. High doses of Vitamin A can lead to toxicity and other health issues. If you are considering vitamin supplements as a means to manage eczema, it's best to consult with a healthcare professional to tailor a treatment plan suited to your individual needs. They can provide guidance on the best approach to optimize your skin health while considering any underlying conditions or sensitivities.
Based on user reviews, the typical time frame to see results from taking this supplement for eczema can vary. Some users have reported noticeable improvements after just 10 days of use, particularly when combined with other treatments (Read Review). Others suggest a longer duration, indicating that consistency is key; for instance, one user noted significant help with their eczema after taking the supplement daily for 2-3 months (Read Review).
Furthermore, individuals have noted varying degrees of improvement, with some experiencing a complete resolution of symptoms and others finding that their symptoms improved but did not completely disappear. For example, one user mentioned that while complete recovery may not be possible, they were pleased with the effects they observed along with other supplements (Read Review). Overall, while individual experiences may differ, users generally report that perseverance over a few weeks to months is likely necessary to gauge the full benefits of the supplement for eczema.
Alitretinoin, a vitamin A derivative, has shown promising results in the treatment of severe chronic hand eczema (CHE) according to scientific research. Multiple studies indicate that alitretinoin not only leads to significant improvements in symptoms but also enhances the overall quality of life for patients who have not responded to conventional therapies. Findings suggest that nearly 30% of patients experience considerable relief from their eczema symptoms when treated with alitretinoin, which generally has a manageable safety profile with mild side effects reported [6][7].
In childhood eczema cases, alitretinoin also appears effective, with studies showing a moderate to excellent response in about 78% of pediatric patients treated. Most patients exhibited improved symptoms and quality of life after using this medication, making it a viable option for those struggling with severe forms of eczema [4]. However, while these findings underline the potential benefits of alitretinoin for eczema, further research is warranted to confirm its efficacy across larger and more diverse populations, especially for those with varying forms of the condition.
Users have reported significant improvements in their eczema symptoms after using this vitamin A supplement. For instance, one reviewer shared that their wife's severe hand dryness and eczema improved markedly, even stating that the dryness disappeared entirely after use (Read Review). Another user noted a complete resolution of inflammation and itching after taking the supplement, crediting it with preventing future flare-ups when used consistently (Read Review).
Moreover, some users have combined this supplement with other vitamins, such as collagen and zinc, to achieve notable results; one individual expressed satisfaction in managing to get rid of their eczema completely, despite the expectation that full recovery might not be feasible (Read Review). Other users reported gradual improvements over time, with a routine of taking the supplement daily for weeks yielding positive outcomes in their skin condition related to eczema (Read Review, Read Review). While individual experiences can vary, these anecdotal accounts suggest that many users have found this supplement beneficial in alleviating eczema symptoms effectively.
Users have reported positive experiences when combining this vitamin A supplement with other dietary elements for managing eczema. One user highlighted their success in completely eliminating eczema after combining these vitamins with collagen, vitamin C, and zinc, expressing satisfaction despite the common expectation of incomplete recovery (Read Review). Meanwhile, another reviewer emphasized the importance of consistent supplementation to maintain skin health and prevent the return of symptoms after resolving inflammation (Read Review).
Additionally, users have noted that taking the supplement as part of a broader regimen, including recommendations from healthcare providers, can yield quicker improvements, with one user mentioning noticeable results in just 10 days when due diligence was observed alongside other medications (Read Review). While individual results can vary, the shared user experiences indicate that the combination of vitamin A with other supplements could be effective for alleviating eczema symptoms.
When it comes to using Vitamin A to manage eczema, alitretinoin—a systemic retinoid form of Vitamin A—has shown promise. Research indicates that the standard dosage of alitretinoin for treating chronic hand eczema (CHE) is typically around 30mg per day. In several studies, patients taking this dosage experienced substantial improvements in their eczema symptoms, with many reporting clearer skin after just one treatment cycle [9]. Notably, a retrospective study of children also indicated a moderate to excellent response to alitretinoin, reinforcing its effectiveness as a treatment option [4].
It is important to keep in mind that while Vitamin A levels, including those from alitretinoin, may correlate with the severity of eczema, no definitive conclusions can be drawn that assert Vitamin A alone mitigates symptoms [1]. Furthermore, while the safety profile of alitretinoin is generally favorable, side effects can occur, necessitating consideration of individual patient circumstances [6]. If you or someone you know is considering this treatment, it’s essential to consult with a healthcare provider to tailor the approach to personal health needs and conditions.
9
Recommended treatment
I ordered this for my son as prescribed by his doctor for his eczema. Combined with other medications, we saw healing starting after 10 days without side effects. I recommend it.
9
Immunity support
1 people found this helpful
It helps a lot with eczema and supports immunity during colds and viruses. I take one capsule a day for 2-3 months, followed by a break.
9
Eczema relief
4 people found this helpful
I combined these vitamins with collagen, vitamin C, and zinc and managed to get rid of eczema. Although it’s said complete recovery isn't possible, I am very pleased!
9
Dryness reduction
10 people found this helpful
My wife has eczema and severe dryness in her hands. After using this vitamin A, her condition improved and the dryness disappeared, thank God.
9
Infection prevention
5 people found this helpful
Easy to drink size. I had eczema and itching on my skin, but after taking the supplement, the inflammation was resolved. If you don't take it, you might not get enough vitamins, and your body will itch and eczema will return. I'll keep this in mind. Great product.
7.5
Improves skin condition
I found this product helpful in improving my skin condition related to eczema.
9
Alitretinoin improves hand eczema
Effectiveness of alitretinoin in severe chronic hand eczema: PASSION, a real-world observational study.
We explored the effectiveness of oral alitretinoin, a vitamin A derivative, for treating severe chronic hand eczema (CHE). With 631 patients participating in this observational study, we administered treatment for up to 24 weeks while monitoring outcomes in real-world conditions.
Our findings were encouraging; by the end of the study, nearly 30% of participants reported significant improvements in their conditions. Utilizing assessments such as the Physician Global Assessment and the EQ-5D quality of life questionnaire, we noted a clear enhancement in patients' overall well-being and work productivity. Notably, quality of life scores increased dramatically from baseline levels, indicating relief for many who suffer from this difficult skin condition.
Moreover, workplace impairment substantially reduced over the course of the study, suggesting that alitretinoin helps not only with the physical symptoms but also allows individuals to return to their daily activities more effectively. Although some patients reported adverse effects, these were generally manageable, and no new safety concerns arose throughout the study.
In summary, we observed that alitretinoin offers significant improvements for those grappling with severe CHE, enhancing both quality of life and ability to work.
9
Alitretinoin treatment effectiveness assessed
Alitretinoin: A Review in Severe Chronic Hand Eczema.
We examined the effectiveness of alitretinoin, a vitamin A derivative, for treating severe chronic hand eczema—especially for those who haven't found relief with strong topical steroids. In clinical trials, participants took alitretinoin daily for up to 24 weeks, and results showed a notable improvement in eczema severity and extent.
Many patients reported their hands becoming 'clear' or 'almost clear,' significantly more than those using a placebo. This exciting finding was consistent in real-world studies as well. Alitretinoin generally proved to be well tolerated, with most side effects being mild, manageable, and reversible.
Overall, we see that alitretinoin stands out as a valuable option for patients struggling with chronic hand eczema that doesn't respond to traditional treatments. It gives hope to individuals who have endured pain and discomfort due to this challenging condition.
8
Alitretinoin shows promise for eczema
Safe and effective use of alitretinoin in children with recalcitrant hand eczema and other dermatoses - a retrospective analysis.
We investigated the effectiveness of alitretinoin, a systemic retinoid related to vitamin A, in treating eczema in children and adolescents. This retrospective study involved chart reviews of patients under 18 years old who received alitretinoin at our pediatric skin center. The focus was to assess how well this treatment worked for chronic hand eczema and other inflammatory skin conditions.
Our results showed promising outcomes, with a noticeable improvement observed in many of the patients. Out of thirteen children treated, approximately 78% with chronic hand eczema displayed a moderate to excellent response after their treatment. The ages of these children ranged from 5.8 to 15.8 years, and they were suffering from conditions like severe atopic dermatitis and specific inherited ichthyoses.
We noted that while alitretinoin appeared safe, the most common side effect was headache, experienced by most patients, which led to treatment interruptions in a few cases. Overall, we can conclude that alitretinoin could be a strong option for treating pediatric eczema, especially for those who haven’t responded well to more conventional topical therapies. However, further research with larger groups will be necessary to confirm these findings and provide more comprehensive guidance.
8
Effectiveness of alitretinoin in eczema
Oral Alitretinoin in the Treatment of Severe Refractory Chronic Hand Eczema in the Spanish National Health System: Description and Analysis of Current Clinical Practice.
We set out to understand how oral alitretinoin, a form of vitamin A, can help patients suffering from severe chronic hand eczema that doesn’t respond to strong topical treatments. Our study involved a thorough analysis of medical records from 62 patients across 13 hospitals in various regions of Spain. We focused on those whose eczema had proven stubborn against typical therapies.
The findings showed that alitretinoin is often used at a consistent dosage of 30mg per day, and most dermatologists noted a satisfactory clinical response after just one treatment cycle. We also saw that the adverse effects reported were largely in line with what is expected from systemic retinoids, indicating a manageable safety profile.
Overall, dermatologists agreed that the benefits of using alitretinoin enhanced patient adherence to therapy and significantly improved their quality of life, allowing for a quicker return to everyday activities like work. While our research suggests that alitretinoin is effective, it is also important to note that we didn’t isolate its effects from other potential treatments.
8
Vitamin A levels, eczema correlation
Changes and clinical significance of serum vitamin A, 25-(OH)D3, TG2, IL-4 and IL-13 levels in children with eczema.
We wanted to understand how vitamin A levels impact the severity of eczema in children. In our research, we analyzed clinical data from 159 children diagnosed with eczema, grouping them based on the severity of their condition—mild, moderate, and severe.
Throughout the study, we made some interesting observations. It became clear that as the severity of eczema increased, the levels of vitamin A declined significantly. We also noted a similar trend with vitamin D levels. Meanwhile, certain inflammatory markers such as TG2, IL-4, and IL-13 rose in correlation with worse symptoms.
This relationship was highlighted by our findings indicating a negative correlation between vitamin A and vitamin D levels and the severity of eczema, measured through SCORAD scores. This means as vitamin A levels dropped, the severity of eczema worsened, while increased inflammatory markers suggested intensifying symptoms.
After three months of treatment, all serum levels, including that of vitamin A, improved significantly across all groups. However, while vitamin A appears to be associated with the severity of eczema, we cannot conclude that vitamin A treatment alone effectively alleviates eczema symptoms, as no specific treatment effects were isolated during our analysis.
Overall, we believe that keeping an eye on vitamin A levels, along with these other markers, can give us valuable insights into eczema severity and treatment responses in children.
References
Li Y, Wang Z, Li X, Ma K, Shi Z. Changes and clinical significance of serum vitamin A, 25-(OH)D3, TG2, IL-4 and IL-13 levels in children with eczema. Arch Dermatol Res. 2025;317:375. 10.1007/s00403-025-03887-8
Kislat A, Olah P, Kuchner M, Gerber PA, Schrader J, et al. The Endogenous Dual Retinoid Receptor Agonist Alitretinoin Exhibits Immunoregulatory Functions on Antigen-Presenting Cells. Int J Mol Sci. 2023;24. 10.3390/ijms24119654
Napolitano M, Potestio L, De Lucia M, Nocerino M, Fabbrocini G, et al. Alitretinoin for the treatment of severe chronic eczema of the hands. Expert Opin Pharmacother. 2022;23:159. 10.1080/14656566.2021.1998457
Luchsinger I, Vogler T, Schwieger-Briel A, Knöpfel N, Wälchli R, et al. Safe and effective use of alitretinoin in children with recalcitrant hand eczema and other dermatoses - a retrospective analysis. J Eur Acad Dermatol Venereol. 2020;34:1037. 10.1111/jdv.16088
Yatsyna IV, Istomin AV, Pogozheva AV, Saarkoppel LM. [Using of specialized food for the workers with skin occupational eczema of perlite production]. Vopr Pitan. 2018;87:45. 10.24411/0042-8833-2018-10030
Thaçi D, Augustin M, Westermayer B, Kamps A, Hennig M. Effectiveness of alitretinoin in severe chronic hand eczema: PASSION, a real-world observational study. J Dermatolog Treat. 2016;27:577.
Blair HA, Scott LJ. Alitretinoin: A Review in Severe Chronic Hand Eczema. Drugs. 2016;76:1271. 10.1007/s40265-016-0621-0
Politiek K, Christoffers WA, Coenraads PJ, Schuttelaar MA. Alitretinoin and acitretin in severe chronic hand eczema; results from a retrospective daily practice study. Dermatol Ther. 2016;29:364. 10.1111/dth.12362
Urrutia S, Roustan G, Plazas MJ, Armengol S, Paz S, et al. Oral Alitretinoin in the Treatment of Severe Refractory Chronic Hand Eczema in the Spanish National Health System: Description and Analysis of Current Clinical Practice. Actas Dermosifiliogr. 2016;107:142. 10.1016/j.ad.2015.08.002