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Journal of Cutaneous Medicine and... 2017Acitretin has been used for the treatment of severe psoriasis for over 20 years. (Review)
Review
BACKGROUND
Acitretin has been used for the treatment of severe psoriasis for over 20 years.
OBJECTIVE
The current project was conceived to optimise patient care by recognising the role acitretin can play in the treatment of patients with psoriasis and those with other disorders of keratinisation.
METHODS
A literature review was conducted to explore the role of acitretin and to assess its value for dermatologic disorders other than severe psoriasis. A panel of Canadian dermatologists developed a clinical pathway using a case-based approach, focusing on specific patient features.
RESULTS
The clinical pathway covers plaque psoriasis with hyperkeratotic plantar disease, palmoplantar pustulosis, hyperkeratotic hand dermatitis, lichen planus, lamellar ichthyosis, and hidradenitis suppurativa.
CONCLUSION
The recommendations in our clinical pathway reflect the current use of acitretin in Canada for severe psoriasis and other disorders of keratinisation.
Topics: Acitretin; Contraindications, Drug; Hidradenitis Suppurativa; Humans; Ichthyosis, Lamellar; Keratoderma, Palmoplantar; Keratolytic Agents; Lichen Planus; Patient Selection; Psoriasis; Skin Diseases
PubMed: 28952335
DOI: 10.1177/1203475417733414 -
Indian Journal of Dermatology,... 2013Acitretin, a synthetic retinoid has gradually replaced etretinate in today's dermatologic practice because of its more favorable pharmacokinetics. Acitretin over the... (Review)
Review
Acitretin, a synthetic retinoid has gradually replaced etretinate in today's dermatologic practice because of its more favorable pharmacokinetics. Acitretin over the past 20 years has proven useful in a number of difficult-to-treat hyperkeratotic and inflammatory dermatoses and nonmelanoma skin cancers. It is effective both as monotherapy and in combination with other drugs for hyperkeratotic disorders. It is considered to be an established second line treatment for psoriasis and exerts its effect mainly due to its antikeratinizing, antiinflammatory, and antiproliferative effect. Its antineoplastic properties make it a useful agent for cancer prophylaxis. Evidence-based efficacy, side-effect profile, and approach to the use of acitretin would be discussed in this review. In addition to its approved uses, the various off label uses will also be highlighted in this section. Since its use is limited by its teratogenic potential and other adverse effects, including mucocutaneous effects and hepatotoxicity, this review would summarize the contraindications and precautions to be exercised before prescribing acitretin.
Topics: Acitretin; Animals; Antineoplastic Agents; Cell Differentiation; Dermatology; Humans; Keratolytic Agents; Precancerous Conditions; Skin Absorption; Skin Diseases
PubMed: 24177607
DOI: 10.4103/0378-6323.120721 -
Journal of the American Academy of... Sep 1999Systemic therapies used in psoriasis such as methotrexate, PUVA, cyclosporine, and acitretin often have side effects that limit their usefulness. Combination therapy, an... (Review)
Review
Systemic therapies used in psoriasis such as methotrexate, PUVA, cyclosporine, and acitretin often have side effects that limit their usefulness. Combination therapy, an effective strategy for treating psoriasis, allows use of lower doses of medications to achieve superior therapeutic results with fewer side effects. Acitretin is one of the most popular drugs used in combination with other systemic therapies for psoriasis. Details of the regimens used and results obtained from combining acitretin with PUVA, cyclosporine, and methotrexate are discussed.
Topics: Acitretin; Combined Modality Therapy; Cyclosporine; Drug Therapy, Combination; Humans; Keratolytic Agents; Methotrexate; PUVA Therapy; Psoriasis; Ultraviolet Therapy
PubMed: 10459142
DOI: 10.1016/s0190-9622(99)70361-0 -
Journal of Cutaneous Medicine and... 2017Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease of the pilosebaceous follicle that severely affects patients' quality of life and can be...
BACKGROUND
Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory disease of the pilosebaceous follicle that severely affects patients' quality of life and can be challenging for clinicians to manage. A few case series have reported on the efficacy of acitretin monotherapy in the treatment of intractable HS.
OBJECTIVE
To assess the efficacy of acitretin for the treatment of intractable HS.
METHODS
A retrospective review was conducted involving all patients with HS who received acitretin between January 2011 and January 2015 in a tertiary academic medical center. All patients with HS who received acitretin, either as a monotherapy or as an adjuvant to other systemic medications, were included, and clinical response was assessed using the physician global scale.
RESULTS
Fourteen patients with HS (mean age 48 years [range 32-64 years]; 9 [64%] were men) received acitretin. Most patients (86%) had Hurley stage II or III disease. All patients had failed other standard systemic medications prior to initiating acitretin. Six patients (43%) received acitretin monotherapy, and 8 patients (57%) received acitretin as an adjuvant to other standard systemic medications. None of the patients who received acitretin monotherapy exhibited clinical improvements. Clinical improvements were observed in 7 of the 8 (87.5%) patients who received acitretin as an adjuvant to other systemic medications, with 3 patients (37.5%) exhibiting partial response and 4 patients (50%) exhibiting good response.
CONCLUSIONS AND RELEVANCE
Acitretin monotherapy was ineffective for the treatment of intractable HS. Acitretin may be effective when used as an adjuvant to other systemic medications.
Topics: Acitretin; Adult; Drug Therapy, Combination; Female; Hidradenitis Suppurativa; Humans; Keratolytic Agents; Male; Middle Aged; Retreatment; Retrospective Studies; Severity of Illness Index; Treatment Outcome
PubMed: 27432818
DOI: 10.1177/1203475416659858 -
Dermatologic Therapy 2013Acitretin, a synthetic retinoid, is the pharmacologically active metabolite of etretinate. It is currently approved by the US Food and Drug Administration for the...
Acitretin, a synthetic retinoid, is the pharmacologically active metabolite of etretinate. It is currently approved by the US Food and Drug Administration for the treatment of severe psoriasis in adults and has been established as a second-line therapy for the treatment of psoriasis resistant to the use of topical therapy. It is also an option for generalized pustular psoriasis, palmoplantar pustulosis, exfoliative erythrodermic psoriasis, and severe psoriasis in the setting of acitretin. It also has been shown to have chemo-preventative characteristics. Acitretin is limited by its teratogenicity and therefore considered inappropriate in most female patients of childbearing age. Common side effects include mucocutaneous dryness and elevated triglycerides.
Topics: Acitretin; Adult; Drug Approval; Drug Resistance; Etretinate; Female; Humans; Keratolytic Agents; Psoriasis; Severity of Illness Index; Teratogens; United States; United States Food and Drug Administration
PubMed: 24099069
DOI: 10.1111/dth.12086 -
Expert Opinion on Drug Metabolism &... Sep 2018Psoriasis is a prevalent cutaneous condition with severe physical and psychological manifestations. Since the advent of biologics, clinical outcomes in psoriasis have... (Review)
Review
Psoriasis is a prevalent cutaneous condition with severe physical and psychological manifestations. Since the advent of biologics, clinical outcomes in psoriasis have improved. However, retinoids are useful in the correct clinical context. Tazarotene and acitretin are currently the only US Food and Drug Administration approved retinoids for treatment of psoriasis. Both topical tazarotene and oral acitretin act on retinoic acid receptors and retinoid-X-receptors, resulting in altered gene expression of inflammatory cytokines and inhibition of keratinocyte proliferation. Areas covered: This article provides an in-depth pharmacologic and clinical review on the use of tazarotene and acitretin in psoriasis. The PubMed database was searched using combinations of keywords: acitretin, bioavailability, dosing, efficacy, etretinate, interactions, mechanism, pharmacodynamics, pharmacokinetics, pharmacogenetics, psoriasis, safety, tazarotene, tolerability, and toxicity. Expert opinion: Tazarotene and acitretin are effective treatments for psoriasis. Benefits include lack of immunosuppression and success treating inflammatory psoriasis. When combined with other topical and systemic agents, both retinoids improve clinical efficacy while lowering the treatment threshold. However, topical adherence and bothersome side effects can limit retinoid use. Acitretin and tazarotene both improve outcomes through a unique mechanism that especially benefits subsets of patients, despite side effects and limitations.
Topics: Acitretin; Administration, Cutaneous; Administration, Oral; Animals; Dermatologic Agents; Humans; Keratolytic Agents; Medication Adherence; Nicotinic Acids; Psoriasis; Treatment Outcome
PubMed: 30134735
DOI: 10.1080/17425255.2018.1515198 -
Annales de Dermatologie Et de... 2019
Topics: Acitretin; Contraindications, Drug; Humans; Keratolytic Agents; Psoriasis
PubMed: 31229350
DOI: 10.1016/j.annder.2019.04.008 -
Journal of the American Academy of... Sep 1999Acitretin is an oral synthetic retinoid effective in the treatment of psoriasis. As monotherapy, acitretin has been shown to be most effective in treating pustular and... (Review)
Review
Acitretin is an oral synthetic retinoid effective in the treatment of psoriasis. As monotherapy, acitretin has been shown to be most effective in treating pustular and erythrodermic types of the disease. Monotherapy with acitretin for plaque-type psoriasis is often less successful; however, its use in combination with other therapies is highly effective in treating this form of the disease. Dose-response studies have established the effective dose range of acitretin as well as the dose-dependence of its side effects. Because both efficacy and side effects can vary substantially among individual patients, proper dosing of acitretin requires a balance between optimizing response and minimizing toxicity for each patient. Optimal dosing for individual patients may be achieved through a dose-escalation strategy involving initiation of therapy at low doses (10 to 25 mg/day) and, if necessary, gradually increasing the dose as tolerated until optimal response is achieved.
Topics: Acitretin; Dose-Response Relationship, Drug; Drug-Related Side Effects and Adverse Reactions; Humans; Keratolytic Agents; Psoriasis
PubMed: 10459141
DOI: 10.1016/s0190-9622(99)70360-9 -
The Journal of Dermatological Treatment Apr 2011Acitretin is a time-honored treatment for psoriasis. During the last decade biologics have revolutionized the treatment of psoriasis. This raises the question: What is... (Review)
Review
Acitretin is a time-honored treatment for psoriasis. During the last decade biologics have revolutionized the treatment of psoriasis. This raises the question: What is the position of acitretin as a classical systemic treatment for psoriasis in the era of biologics? Based on the mode of action of acitretin, it is evident that at least one antipsoriatic treatment has to be available in the armamentarium of antipsoriatic treatments that is not immunosuppressive, intended for those patients who are contraindicated for immunosuppressive treatment. It is attractive to speculate that at least an additive or possibly a synergistic effect can be expected in case of combination of acitretin with a biologic. The efficacy of acitretin in chronic plaque psoriasis as a monotherapy is below methotrexate and cyclosporine. However, acitretin in combination with phototherapy has an efficacy at least comparable with the other classical systemic treatments. Based on several clinical studies it can be concluded that acitretin is an important treatment option in case of contraindications for immunosuppression, such as patients with infections or cancer-prone patients. Furthermore, some evidence is available for high efficacy of the combination of acitretin and biologics.
Topics: Acitretin; Drug Therapy, Combination; Humans; Keratolytic Agents; Psoriasis
PubMed: 20673152
DOI: 10.3109/09546630903578582 -
Journal of Drugs in Dermatology : JDD Jul 2011Acitretin is a systemic retinoid drug used in the treatment of severe psoriasis. It has also been used for a spectrum of other difficult-to-treat dermatoses, including... (Review)
Review
INTRODUCTION
Acitretin is a systemic retinoid drug used in the treatment of severe psoriasis. It has also been used for a spectrum of other difficult-to-treat dermatoses, including hyperkeratotic and inflammatory dermatoses and non-melanoma skin cancers. Here we review the available data regarding both FDA-approved and off-label uses of acitretin, clinically relevant adverse events, precautions and monitoring.
METHODS
A PubMed literature search was conducted utilizing the search term "acitretin," which yielded 714 hits. Results were further limited to English language clinical trials in human subjects. Of 78 articles evaluated for relevance, 60 were included for review.
RESULTS
Acitretin is effective as monotherapy and in multidrug therapeutic regimens for the treatment of psoriasis and other hyperkeratotic and inflammatory disorders, as well as for malignancy chemoprevention. Its use is limited by its teratogenic potential and other adverse effects, including mucocutaneous effects and hepatotoxicity. Potential adverse effects may be reduced or avoided by using lower doses of acitretin or in combination with other therapies.
LIMITATIONS
The reviewed studies include many small trials and case reports of the use of acitretin for psoriasis. Studies of acitretin therapy for the treatment of other cutaneous disorders are limited.
CONCLUSION
Acitretin is a beneficial treatment for psoriasis, and should be considered when not contraindicated. Particularly when used in combination with ultraviolet (UV) phototherapy, is a safe and cost effective therapeutic strategy.
Topics: Acitretin; Humans; Keratolytic Agents; Off-Label Use; Psoriasis; Skin Diseases; Skin Neoplasms
PubMed: 21720660
DOI: No ID Found