Medication

Alitretinoin

Alitretinoin is two different medicines with the same name. In the US, it is only available as Panretin, a topical gel for the skin lesions of AIDS-related Kaposi sarcoma. The oral capsule used for severe chronic hand eczema is approved in Canada and much of Europe, but it is not approved in the United States.

At a Glance

Alitretinoin is a retinoid — a vitamin A derivative — that exists in two very different products. The topical 0.1% gel, brand name Panretin, is FDA-approved in the US to treat cutaneous lesions of AIDS-related Kaposi sarcoma. The oral capsule, brand name Toctino, is the drug most people are actually searching for: it treats severe chronic hand eczema that has not responded to strong topical steroids. Toctino is licensed in Canada, the UK, and much of Europe. It has never been approved in the US.

Key Facts

AKA	Panretin (topical gel, US), Toctino (oral capsule, not available in the US)
Drug Class	Retinoid (vitamin A derivative). Binds both families of retinoid receptor
Rx or OTC	Prescription only
Typical Strength	Panretin gel 0.1%, applied two to four times a day. Oral alitretinoin, where available, is 10 mg or 30 mg once daily
Time to Work	Kaposi sarcoma lesions: several weeks to a few months. Oral, for hand eczema: usually 8 to 24 weeks
Evidence Level	Good for AIDS-related Kaposi sarcoma skin lesions. Good for severe chronic hand eczema, where the oral drug is licensed
Important	Contraindicated in pregnancy. The oral form is not FDA-approved and cannot be prescribed in the US.

How It Works

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Retinoids act on receptors inside the cell nucleus that control which genes are switched on. There are two families: retinoic acid receptors (RARs) and retinoid X receptors (RXRs). Most retinoids activate only the first family. Alitretinoin activates both, which is unusual and is the reason it behaves differently from other retinoids.

In Kaposi sarcoma. Kaposi sarcoma is a cancer of the cells that line blood and lymph vessels, driven by a herpesvirus in people with weakened immune systems. Applied to a lesion, alitretinoin slows the growth of the tumor cells and pushes them toward normal maturation, and the lesion flattens and fades. It works on the skin lesions it is applied to. It does nothing for disease elsewhere in the body, which is why it is not used when systemic treatment is needed.

In chronic hand eczema. Taken by mouth, alitretinoin damps down inflammation and changes how the thickened, cracked skin of the palms behaves. It is used for the stubborn hyperkeratotic type — thick, fissured, painful hands — that has not responded to potent topical steroids. It is not a first-line eczema drug anywhere; it is what comes after strong topicals have failed.

What It Treats

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Hand Dermatitis

Moderate evidence

Alitretinoin is an oral retinoid licensed for severe chronic hand eczema unresponsive to potent topical steroids. It is not available in the United States.

Who It's For & Who It's Not

Who it's for

The topical gel: adults with AIDS-related Kaposi sarcoma who have skin lesions that need treating and do not need systemic anti-cancer therapy.

The oral capsule, where it is licensed: adults with severe chronic hand dermatitis that has not responded to at least a proper course of a potent topical steroid.

Who it's not for

Anyone who is pregnant, planning pregnancy, or unable to use reliable contraception. This is absolute for both forms.

Anyone in the US looking for oral alitretinoin — it is not approved here and cannot be prescribed.

People with Kaposi sarcoma that is progressing internally or too widespread for a topical to reach.

How to Take It

How to take the gel

Panretin gel is applied to the Kaposi sarcoma lesions themselves, generously enough to coat them, and allowed to dry for a few minutes before covering with clothing. It usually starts at twice a day and is increased gradually, up to four times a day, as the skin tolerates it. Keep it off normal skin around the lesion and off mucous membranes. Do not cover it with an airtight dressing — that increases absorption and irritation.

The DEET warning

Do not use insect repellent containing DEET while using Panretin gel. This combination is specifically warned against on the label.

How the oral drug is taken where it is licensed

One capsule daily with a meal, since it is fat-soluble and absorbed better with food. Courses run around 12 to 24 weeks, with blood tests and, for anyone who can become pregnant, a pregnancy prevention program. This is described for information only — it is not available in the US.

What to Avoid

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Pregnancy

Alitretinoin is a retinoid and can cause serious birth defects. Both forms are contraindicated in pregnancy. The gel label advises effective contraception during treatment and for a week after; the oral drug requires a formal pregnancy prevention program with regular testing in the countries where it is sold.

DEET

Do not use DEET-containing insect repellent with Panretin gel.

Sun on treated skin

Retinoid-treated skin burns more easily. Cover treated lesions or use sunscreen on them.

Occlusive dressings

over the gel.

Vitamin A supplements

if you are taking the oral form. Stacking vitamin A on top of a retinoid stacks the toxicity.

Tetracycline antibiotics

with the oral form, because of the risk of raised pressure around the brain — the same interaction that applies to isotretinoin.

Side Effects

Common and expected

With the gel, almost all side effects happen where you put it:
Rash, redness, and scaling at the application site. This is the most common reaction and often the reason the dose is reduced.
Burning, stinging, or pain at the site.
Itching.
Peeling or flaking of the treated skin.
Swelling around the treated area.
Reactions are usually mild to moderate, but a minority of people get severe irritation and need to cut back to once a day or pause treatment.
With the oral drug, the pattern is the familiar systemic retinoid one: headache (common, especially in the first weeks and more so at the higher dose), dry lips and eyes, raised cholesterol and triglycerides, and a fall in thyroid hormone levels in some people.

Tell your doctor

Skin at the site that becomes raw, weeping, or blistered.
A headache that is persistent or severe on the oral drug.
Any visual change on the oral drug.
Kaposi sarcoma lesions that are enlarging or spreading rather than flattening — the gel treats what you apply it to, and progression means the plan needs revisiting.

Stop and get care

Severe allergic reaction — hives, facial or throat swelling, trouble breathing.
Severe headache with vision changes or vomiting on the oral drug. This can indicate raised pressure around the brain and needs urgent assessment.
If you become pregnant, stop immediately and contact your prescriber.

Monitoring

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The topical gel does not require routine blood tests. Treated lesions are reviewed periodically to see whether they are responding, and the frequency of application is adjusted up or down based on irritation.

Oral alitretinoin, in countries where it is licensed, does require monitoring: liver function, cholesterol and triglycerides, and thyroid function before starting and periodically during the course. Anyone who can become pregnant needs a negative pregnancy test before starting, monthly tests during treatment, and reliable contraception for the course and for a period afterward.

How Long Until It Works

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Panretin gel is slow. Most people who respond see the lesion begin to flatten and lose color over several weeks, and the label's own trials ran for 12 weeks and beyond. Some lesions respond and others on the same person do not. It is worth continuing for at least two to three months before calling it a failure, provided the skin tolerates it.

Oral alitretinoin for hand eczema typically shows meaningful change by 8 weeks, with the full effect at the end of a 12 to 24 week course. Hands that are going to clear usually clear within that window.

What Happens When You Stop

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With the gel, Kaposi sarcoma lesions can regrow after treatment stops, since the drug controls local growth rather than eliminating the underlying disease. The most important factor in AIDS-related Kaposi sarcoma is control of HIV itself — effective antiretroviral therapy does more for the disease than any topical does.

With the oral drug, chronic hand eczema relapses in a substantial share of people after a course ends, often within months. Repeat courses are given in the countries where it is licensed, and many people who relapse respond again.

There is no withdrawal effect and no taper with either form.

Who should not take it+

Do not use alitretinoin if:

You are pregnant, planning pregnancy, or cannot use reliable contraception You are breastfeeding You are allergic to retinoids or any ingredient in the product

For the oral form, it is also avoided in people with uncontrolled high cholesterol or triglycerides, significant liver disease, or poorly controlled thyroid disease.

FAQ+

Can I get oral alitretinoin in the United States?No. Oral alitretinoin (Toctino) has never been approved by the FDA. It is licensed in Canada, the UK, and much of Europe for severe chronic hand eczema, but US pharmacies do not carry it and US dermatologists cannot prescribe it. The only alitretinoin product available in the US is Panretin gel, and that is approved for a completely different purpose.

Is Panretin the same drug as Toctino?Same active molecule, entirely different product. Panretin is a 0.1% gel you rub on Kaposi sarcoma lesions; it stays largely in the skin where you apply it. Toctino is a capsule that works through the whole body. You cannot use the gel to treat hand dermatitis — the gel has never been shown to work for eczema and applying it to cracked hands would mostly just hurt.

What should I use for severe hand eczema in the US then?The usual sequence is a potent or superpotent topical steroid such as clobetasol under a proper regimen, plus relentless barrier care and avoidance of triggers. If that fails, options include topical tacrolimus, hand phototherapy, dupilumab, and older systemic drugs such as methotrexate or cyclosporine. Which one fits depends on what type of hand eczema you have, so getting the diagnosis right matters more than chasing a specific drug.

Does Panretin cure Kaposi sarcoma?No. It treats the individual skin lesions you apply it to. It does not treat disease in the lymph nodes, gut, or lungs, and it does not address the immune suppression that allows Kaposi sarcoma to develop. Effective HIV treatment is the foundation; the gel is a local measure for cosmetically or physically troublesome lesions.

Why does it burn so much?Because it is a potent retinoid applied repeatedly to the same patch of skin, often several times a day. Irritation at the site is the most common side effect and the usual reason the frequency is reduced. Cutting back to once or twice daily, or pausing for a few days, generally settles it.

Can I use insect repellent while using the gel?Not one containing DEET. That specific combination is warned against on the label.

Is it safe in pregnancy?No. It is a retinoid, and retinoids can cause serious birth defects. Both the gel and the oral form are contraindicated in pregnancy, and reliable contraception is required.