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Papulosquamous Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Melek Aslan Kayıran, Jordan V. Wang, Ayşe Serap Karadağ
Acitretin can be used in all types of psoriasis and can be especially helpful in pustular psoriasis. Response can be observed after 4–6 weeks, but maximal effect is typically seen after 3–4 months. Once the disease stabilizes, the dose can be reduced for maintenance. Side effects are generally dose dependent and include skin dryness, cheilitis, palmoplantar desquamation, irritation, myalgia, hair loss, increased triglycerides, and increased liver function markers. Acitretin should not be used in women of childbearing age due to its teratogenicity.
Retinoids and Concomitant Surgery
Published in Ayse Serap Karadag, Berna Aksoy, Lawrence Charles Parish, Retinoids in Dermatology, 2019
Oral retinoids, especially isotretinoin and acitretin, are used to treat acne and other dermatologic conditions. Accordingly, the number of patients who take systemic retinoid therapy and wish for or need surgical treatment has also increased. Isotretinoin (its isomer 13-cis retinoic acid) is a non-aromatic, first-generation systemic retinoid that was first introduced in 1982 for the treatment of acne and is currently used to treat a variety of dermatologic disorders. Acitretin is a mono-aromatic, second-generation systemic retinoid (a metabolite of etretinate). Acitretin is used to treat psoriasis and several other dermatologic diseases, as well as in the chemoprevention of skin cancer.
Pustular psoriasis
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Santanu Banerjee, Neerja Saraswat
At such high doses, patients may develop serious side effects of pseudotumor cerebri and acute hypertriglyceridemia causing pancreatitis. There are minor, reversible, dose-dependent side effects including hair loss, periungual fibroma, xerosis, cheilitis, dry mucous membranes, hypertriglyceridemia, hair loss, liver function test abnormalities, bone changes, and visual changes which usually resolve when the dose of acitretin is reduced.
Safety of current systemic therapies for nail psoriasis
Published in Expert Opinion on Drug Safety, 2023
Jonathan K. Hwang, Shari R. Lipner
Acitretin is a retinoic acid receptor modulator, and its metabolites bind to retinoic acid receptors, leading to antiproliferative and anti-inflammatory effects [98]. For nail psoriasis, recommended dosing is 0.2–0.4 mg/kg daily for at least 6 months, or until at least a moderate improvement is documented [7]. Efficacy of acitretin for nail outcomes was demonstrated in an open-label clinical trial of 36 nail psoriasis patients, treated with 0.2–0.3 mg/kg daily, with a 41% reduction in mean NAPSI score at 6 months [99]. AEs of severe dryness of periungual skin and multiple pyogenic granulomas were reported in one patient, a 49-year-old woman receiving a daily dosage of 0.3 mg/kg. For psoriasis overall, efficacy is lower than that of targeted therapies, as well as that of other conventional systemic agents [82].
Perspectives on the pharmacological management of psoriasis in pediatric and adolescent patients
Published in Expert Review of Clinical Pharmacology, 2021
Emmanuel Mahé, Maud Amy De La Bretêque, Céline Phan
Acitretin is used as the first-line systemic therapy for moderate-to-severe psoriasis in children in several countries. Its efficacy, measured as the rate of complete or almost complete disease resolution, has been estimated at 60–75% in plaque psoriasis, with higher rates being obtained in palmoplantar and generalized pustular psoriasis [1]. However, this treatment is not effective in psoriatic arthritis. The efficiency of the treatment is slow, and 2 to 3 months of therapy are usually needed before efficacy can be evaluated in plaque psoriasis, whereas pustular psoriasis may respond in as early as 3 weeks. The efficacy of acitretin can be improved by combining this treatment with phototherapy, and, potentially, with methotrexate. The absorption of acitretin is highly variable from one subject to another. It is the same for the sensitivity to this molecule. Acitretin is usually initiated at a starting dose of 0.1–0.5 mg/kg/day, after which the dose can be increased to up to 1 mg/kg/day. As the agent is only available in formulations of 10 mg and 25 mg, finding the optimal dose can be problematic. To obtain an average dose of 5 mg/kg/day, a patient would need to take 10 mg every other day. Likewise, to obtain an average dose of 15 mg/kg/day, a patient would need to alternate between taking 10 mg and 20 mg every other day. Once the treatment is effective, the dose should be gradually reduced to determine the minimum effective dose and limit the risk of adverse events [1,3,11,46].
Safety considerations with combination therapies for psoriasis
Published in Expert Opinion on Drug Safety, 2020
Combining acitretin with phototherapy leads to synergistic effects, reducing the number of treatments and cumulative UV and acitretin doses required for clearance. Furthermore, acitretin can be a useful agent to prevent occurrence of skin cancer [63] and is therefore an ideal agent to combine with phototherapy, especially PUVA, which has cutaneous carcinogenic effects in Caucasian patients after more than 200 to 250 treatments [64]. When used with phototherapy, the dose of acitretin should be 25 mg/day or less. If acitretin is initiated first, phototherapy should be started approximately 2 weeks later per the usual dosing protocol. If acitretin is added to an established phototherapy regimen, the UV dose should be decreased by 50% to prevent burn, as acitretin decreases the MED [65].