Therapy with Oral Acitretin (a vitamin A derivative)

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

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