Intracranial hypertension following alitretinoin treatment for chronic hand eczema: a case report

Alitretinoin is an effective systemic treatment for chronic hand eczema (CHE); however, its use can rarely result in dangerous intracranial hypertension (ICH) despite headache being a common but typically mild side effect. We present a case of a 24-year-old woman who had been taking alitretinoin 30mg/day for seven months for CHE and subsequently developed secondary ICH. She visited a headache clinic with complaints of persistent and pulsatile headaches for one month, accompanied by symptoms such as blurred vision, nausea, tinnitus in the left ear, photophobia, and phonophobia. The headaches were most severe in the evening and worsened upon waking in the morning. Physical examinations revealed papilledema in both eyes and elevated cerebrospinal fluid (CSF) pressure (32 cmH2O). Brain MRI showed ICH sign such as the posterior globe fattening and empty sella, but laboratory findings, including serum vitamin A levels, were normal. The patient was diagnosed with secondary ICH associated with alitretinoin use. Treatment comprised CSF drainage, mannitol, and acetazolamide, and she was discharged without complications after a week. Subsequent follow-up showed no recurrence of symptoms. As ICH can cause permanent brain and eye damage, it is crucial to promptly diagnose and treat the condition to prevent lasting visual impairment. Therefore, physicians should carefully examine patients undergoing alitretinoin treatment who have headaches.