ACITRETIN

Note: This is a summary only. The full FDA and packaging information should be consulted before prescribing acitretin. Acitretin is a second generation monoaromatic retinoid, and is the major active metabolite of etretinate.

Indications

Acitretin is approved for patients with psoriasis. The TAPP program (take action to prevent pregnancy) is to prevent pregnancy in woman of child-bearing potential receiving acitretin.

Precautions, Especially for Women

Dose

Typical doses for psoriasis are 25-50 mg PO QD

Alcohol

When patient on acitretin drinks alcohol, acitretin can convert back to etretinate.

Pregnancy Category X

Because acitretin can be metabolized to etretinate, a 3 year post therapy contraceptive period is recommended.

Laboratory Monitoring

Side Effects

The side effects are many and include, but are not limited to:

SPINE

When given longterm, bony abnormalities may rarely occur. In one prospective study, radiographs of the pelvis, forearms and knees were of most practical value [BJD 1996;134;1151]. They should be done at baseline and every second year. Pain in the arm or limited mobility were signs in one patient of ossification of an interosseous membrane between the ulna and the radius. Extraspinous ossification may occur even if spinal xrays are normal [JAAD 1995;32;322]. Thus, ask for pain and decreased mobility, e.g. of hips.

Muscle

Acitretin was reported to cause severe proximal weakness of all four extremities plus elevated CPK [BJD 1996;134;977]. Isotretinoin has caused reversible myopathy [BMJ 1986;293;425].

Hair

Acitretin may thin the hair. In one of my patients, the hair grew back curly and slowly reverted back to normal (straight) over 18 months. Repigmenation and curling of hair has been described [CED 2014;39;58O].

Edema

1-10% of patients may develop edema of the legs.

Cushing's Syndrome

The combination of acitretin and occluded clobetasol for the treatment of palmoplantar psoriasis lead to Cushing's syndrome in 2 children [PD 2017;34;219].

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