Atopic Dermatitis: a Short Summary
Acitretin:
- is a metabolite of etretinate
- is FDA-approved for use in psoriasis
- is less lipophilic than the former and fat storage (half life 120 days):
- It is highly highly toxic to embryos during pregnancies (teratogenic) and contraception in women must be used for at least 2 years (come say 3 three years)
- no safe dosage: it remains teratogenic at any dose.
- Tip: do not use in women of childbearing age except if there is a history of skin cancers following organ transplant
- the frequent side effects include:
- dry skin (xerosis)
- alopecia: telogen effluvium is seen at doses if 25mg and upwards
- no use giving it it women with childbearing except if history of cancers following transplant
- Uses:
- pustular psoriasis
- plaque psoriasis: when combined with phototherapy (UVB or PUVA) it speeds up response and can be used at lower doses
- palm psoriasis
- pediatric psoriasis: off-label tiny 10mg dosage every 4 days: growth problems* not observed (parents are afraid to use biologics in this group)*retinoids can cause premature closure of the epiyphses
- Its most useful usage according to the presenter is “off label”:
- PRP (Pityriasis Rubra Pilaris)
- acitretin is useful especially in the inherited kind
- biologics are more effective in acquired PRP
- keratinizing disorders (Darier’s, keratodermas…)
- other:
- chemoprevention of skin cancers:
- Muir Torre Syndrome: 10-40mg per day to suppress sebaceous carcinomas
- immunosuppression-induced increases incidence of skin cancers
- 25mg indicated but 10mg enough in author’s experience
- reduces SCC (Squamous Cell Carcinoma) from appearing and its malignant behavior
- chemoprevention of skin cancers:
- PRP (Pityriasis Rubra Pilaris)
Contributors:
Dr Christophe HSU – dermatologist. Geneva, Switzerland
S002 – Jackson JM et al. Systemic Therapies for Dermatologists: a Comprehensive Review and Update
AAD 2015 Annual Meeting, San Francisco CA – United States
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