Treatment of psoriasis with etretin: a preliminary report. The best response occurred in those patients with the most extensive initial plaque involvement or palmoplantar pustulosis. The clinical side effects were similar to those reported with use of etretinate and seemed to be related to the dose. Chronic palmoplantar pustular psoriasis (PPP) is a disabling condition characterized by recurrent crops of sterile pustules on a background of erythema, fissuring and scaling. Its effects and side effects are similar to synthetic retinoids but it is not believed to have a prolonged action following withdrawal. Acitretin, a synthetic retinoid has gradually replaced etretinate in today’s dermatologic practice because of its more favorable pharmacokinetics. Palmoplantar pustulosis: In two randomized controlled trials (RCTs) Expand comparing acitretin with placebo in palmoplantar pustulosis, acitretin was significantly more effective than placebo, acting within 4 weeks to produce a 5-fold reduction in pustules.
Like all the synthetic retinoids, etretinate is highly teratogenic, and this risk further increased by the drug’s long elimination half-life greatly restricted its use in women of reproductive potential. IndicationsThe summary of product characteristics (SPC) for Neotigason specifies the following indications: severe extensive psoriasis that is resistant to other forms of therapy, palmoplantar pustular psoriasis, severe congenital ichthyosis, and severe Darier disease. Etretinate therapy represents an effective and economical alternative to hospitalization for psoriasis treatment. Vertebral abnormalities associated with synthetic retinoid use. Three generations of synthetic retinoids have since been developed (Fig. Acitretin has replaced etretinate in most countries, but not in Japan and a few other countries.
Palmoplantar pustulosis and sternocostoclavicular arthro-osteitis. Acitretin is a second generation retinoid (a vitamin A derivative) used as an oral systemic therapy for patients with psoriasis that is too extensive and/or severe for topical treatment. Acitretin may be a good choice for patients with history of melanoma, solid tumors, lymphoproliferative malignancies or HIV because its mechanism of action does not involve significant immunosuppression. Acitretin induced 5-fold reduction in pustules after 4 weeks in 2 RCTs in patients with palmoplantar pustulosis. But as long as acitretin is not used in women of childbearing potential, the potential conversion to etretinate caused by concurrent use of alcohol may be of no clinical significance. All synthetic & natural compounds that have biologic activity similar to Vitamin A. Lichen planus- oral erosive, palmoplantar Lichen sclerosus et atrophicus; 33.
Guidelines For The Use Of Acitretin In Psoriasis
To evaluate the clinical-effectiveness of etretinate in the treatment of papilloma virus infections, 20 children with extensive warts were given this oral retinoid for a period not exceeding three months at a dosage of 1 mg per kg per day.acid) was the most potent retinoid, whereas etretinate and retinol had the lowest potency. Acitretin, a synthetic retinoid has gradually replaced etretinate in today’s dermatologic practice because of its more favorable pharmacokinetics. Twenty patients with palmoplantar pustulosis (PPP) were treated with topical PUVA, oral etretinate (Re), or combined PUVA and etretinate (Re-PUVA). For example, isotretinoin is very effective for severe, therapy-refractory forms of acne, as compared to etretinate. Acitretin is the most important metabolite of etretinate and has even better pharmacokinetic characteristics at a comparable efficacy profile.