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Use of Dermatologics during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Etretinate is an oral retinoid used to treat psoriasis. Etretinate may be detected in serum at therapeutic levels at least two years following therapy cessation (DiGiovanna et al., 1984). Near-therapeutic levels of etretinate may be detected for three to seven years following cessation of therapy (Hoffman-LaRoche, personal communication). No epidemiological studies are published of infants born to women who used etretinate during pregnancy. Twenty-nine live-born infants were reported among 43 pregnancies exposed to etretinate, of whom six had major congenital anomalies; five infants had malformations similar to retinoid embryopathy (Geiger et al., 1994). There are case reports of neural tube defects, other central nervous system malformations, and limb reduction defects in the offspring of mothers exposed to this drug during embryogenesis (Happle et al., 1984; Lammer, 1988; Rosa et al., 1986; Verloes et al., 1990). In one published case report, a fetus with a hypoplastic leg was born to a mother who conceived several months after discontinuing etretinate (Grote et al., 1985).
Psoriasis
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Acitretin should be administered at a lower dose than that used in skin psoriasis, 0.3–0.5 mg/kg, in order to avoid the side effects related to retinoids, such as nail fragility, reduction of nail thickness, paronychia-like lesions, and pseudopyogenic granulomas. Etretinate was prescribed in 46 patients with pustular psoriasis with excellent results.
Pharmacology of Therapeutic Agents in Photomedicine
Published in Henry W. Lim, Nicholas A. Soter, Clinical Photomedicine, 2018
Ira C. Davis, Matthew J. Stiller, Jerome L. Shupack
Chronic effects may involve the skeletal system and the liver. Premature closure of the epiphyses, thinning of the long bones, fractures, and osteoporosis are among the reported side effects in children (60). Adults have developed a disorder resembling diffuse idiopathic skeletal hyperostosis; spinal hyperostoses, extraspinal ligament and tendon calcification, and spinal osteophytes. Liver toxicity may occur with chronic use of etretinate. A 3-year, 20-patient prospective study failed to demonstrate increased hepatotoxicity in high-risk patients treated with etretinate (61). However, in a retrospective study of 18 patients taking etretinate for more than 5 years, 4 patients had mild to severe portal fibrosis defined by formation of septa extending into the lobule or cirrhosis (62). Most patients in this study did not have pretreatment liver biopsies.
Generalized pustular psoriasis: current management status and unmet medical needs in Japan
Published in Expert Review of Clinical Immunology, 2021
Mayumi Komine, Akimichi Morita
In adults, the first-line recommendation for the treatment of skin symptoms is etretinate (a retinoid); this is based on numerous case reports and case series, and experience from the Japanese clinical database survey in which etretinate accounted for 35.6% of oral medications, with an efficacy rate of 87.1% [1]. Etretinate cannot be prescribed to pregnant women because of potential teratogenesis, and requires careful monitoring for adverse events such as hepatic impairment and hyperostosis [1]. Notably, most other countries prescribe acitretin as the retinoid of choice because of its shorter half-life [1]. Cyclosporine is also recommended as first-line option based on case reports and case series, and on 37.8% usage and 87.6% efficacy in the Japanese national clinical database survey [1]. In patients who do not respond to etretinate or cyclosporine alone, methotrexate may be added, bearing in mind a long list of contraindications including pregnancy, alcohol liver disease, chronic hepatitis, and diabetes mellitus. Methotrexate is also the treatment of choice for patients with severe arthritis [1].
A systematic review of treatment strategies for erythrodermic psoriasis
Published in Journal of Dermatological Treatment, 2021
Kelly A. Reynolds, Deeti J. Pithadia, Erica B. Lee, Wilson Liao, Jashin J. Wu
The evidence supporting the use of oral retinoids in EP is mixed. One case series reported satisfactory results in 10 of 12 patients treated with etretinate 20 to 60 mg per day after 2 to 11 months of treatment (8). Rosinska et al reported only two of five patients with EP had favorable results after one to four months of treatment with etretinate (11). In a retrospective review of two patients with EP treated with acitretin, neither achieved a clinical response after three months of treatment (5). One case series of three patients demonstrated complete remission after 11 to 18 days of treatment with cyclosporine (3.5–4 mg/kg per day) plus etritinate (0.5–0.5 mg/kg per day) (9). Commonly reported side effects of retinoids included cheilitis and lipid abnormalities (8). One pediatric patient treated with etretinate developed focal osteoporosis of the tibia (11).
Systemic medications used in treatment of common dermatological conditions: safety profile with respect to pregnancy, breast feeding and content in seminal fluid
Published in Journal of Dermatological Treatment, 2019
Sarah Madeline Brown, Khadija Aljefri, Rachel Waas, Philip Hampton
Acitretin is a potent teratogen. It is a vitamin A derivative and an active metabolite of etretinate (1). Acitretin has been associated with multiple case reports of retinoic acid embryopathy when taken by women during pregnancy and also following cessation of therapy (2). A characteristic pattern of malformations with facial dysmorphia, cleft palate, cardiovascular malformations (aortic arch abnormalities and atrial or ventricular septal defects), central nervous system malformations, thymic abnormalities, neurodevelopmental delay and limb and skeletal defects is seen (3,4). Plasma concentration assays of acitretin correlate poorly with its concentration in the subcutaneous fat with the latter being much higher, therefore serum levels are not helpful to monitor elimination (1,5). Acitretin product guidance advises alcohol avoidance. Alcohol can convert acitretin back to etretinate which has a longer elimination half-life of up to 168 days (1,6,7). Etretinate is highly lipophilic and accumulates in adipose tissue where it can be detected up to 3 years after administration (3). Hence, women of childbearing age should be advised to use two forms of contraception whilst on acitretin and for 3 years following cessation of treatment and should not become pregnant during this time period (1).