In its Final Appraisal Determination on alitretinoin, NICE has recommended it, within its licensed indication, as a treatment option for adults with severe chronic hand eczema that has not responded to potent topical corticosteroids, providing the person has severe disease, as defined by the physician’s global assessment (PGA) and a dermatology life quality index (DLQI) score of 15 or more. Alitretinoin treatment should be stopped as soon as an adequate response (hands clear or almost clear) has been achieved or if the eczema remains severe (as defined by the PGA) at 12 weeks or if an adequate response (hands clear or almost clear) has not been achieved by 24 weeks. Only dermatologists, or physicians with experience in both managing severe chronic hand eczema and the use of systemic retinoids, should start and monitor treatment with alitretinoin. The appeal period for this appraisal will close on 30th July 2009.