Ciclosporin Versus Alitretinoin for Severe Atopic Hand Dermatitis.

Inclusion Criteria: * Male and female Patients age \> 18 years and ≤ 75 years * Body weight 50 to 100 kg * Chronic hand dermatitis (duration \> 6 months) * Atopic constitution according to * Erlanger Atopiescore1 and/or * positive personal history for atopic eczema, allergic rhinitis, allergic asthma and/or * elevated serum IgE * Severe hand dermatitis not responding to treatment with potent topical steroids for at least 4 weeks within the past 6 months due to IGA * Written informed consent Exclusion Criteria: * Participation in other clinical trial within past 4 weeks * Pregnancy/breastfeeding * Women within reproductive age except those women who fulfil at least one of the following criteria throughout the total study and until at least 5 weeks after active study treatment in case of early study termination: * post-menopausal women (12 months physiological amenorrhoea or 6 months amenorrhoea with serum FSH level \> 40 mlU/ml), * postoperative (6 weeks after bilateral ovariectomy with or without hysterectomy) * Regular and proper use of at least two methods of contraception, including at least one method of contraception with a failure rate \<1% per year (eg, implants, depot preparations, oral contraceptives, IUD). * vasectomy of the partner. * Women within reproductive age, who do not meet all of the following criteria throughout the whole study or - in case of early study termination - up to 5 weeks after active therapy: * The patient understands the teratogenic risk associated with taking the study medication. * The patient understands the need for strict monthly monitoring, the need for a reliable, continuous contraception and the need for regular pregnancy tests throughout the study and - in case of early study termination - up to 5 weeks of active therapy. * The patient is able to adequately and reliably apply methods of contraception. * The patient is informed about the possible consequences of pregnancy and knows that she must immediately contact her physician in case of suspected pregnancy. * The patient gives informed consent about knowing the potential risks and necessary measures to avoid pregnancy. * Blood and/or plasma donation during the whole study period. In case of early study termination blood and plasma donation is not allowed until 1 month after the end of active study treatment * UV-therapy within past 3 months * Concurrent photo-and / or photochemotherapy * Known Hypersensitivity / Intolerance against ciclosporin, alitretinoin or any other ingredients of Immunosporin® or Toctino® * Known Allergy against peanuts or soya * Known Hereditary fructose intolerance * Acute and/or uncontrolled chronic infectious disease * Known Congenital or acquired immune deficiency * Malignant tumor (past or present) * Uncontrolled arterial hypertension (RR systolic ≥ 160 mm Hg and/or RR diastolic≥ 90 mm Hg despite anti-hypertensive treatment) * Renal insufficiency (Serum creatinine above normal range) * Liver insufficiency (CHILD ≥ Stadium B) * Not sufficiently controlled hyperlipidemia (LDL/HDL ratio \> 4 despite medical treatment) * Clinically significant thyroid hypofunction * Known Hypervitaminosis A * Concurrent supplementation of vitamin A or treatment with other retinoids * Concurrent tetracycline therapy * Concurrent therapy with St. John's wort ("Johanniskraut") * Known genetic diseases causing increased UV light sensitivity such as Xeroderma pigmentosum, Cockayne-syndrome, Bloom syndrome * Known Drug- and/or alcohol abuse * Known significant psychiatric morbidity