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Acitretin

SKIN

DEPIGMENTATION & MELANIZING AGENTS - [ SKIN ]

Acitretin is a metabolite of the aromatic retinoid etretinate, is quite effective in the treatment of psoriasis, especially pustular forms. Its use in pregnanat women is contraindicated due to risk of teratogenicity. (1)

Severe extensive psoriasis resistant to other forms of therapy Palmoplantar pustular psoriasis Severe congenital ichthyosis Severe darier’s disease (keratosis follicularis) (1,2)

Severely impaired liver or kidney function Patients with chronic abnormally elevated blood lipid values Pregnancy and lactation (2)

Dryness of mucous membranes (sometimes erosion), of skin (sometimes scaling, thinning, erythema especially of face, and pruritus), and of conjunctiva (sometimes conjunctivitis and decreased tolerance of contact lenses); Sticky skin, dermatitis Palmoplantar exfoliation Epistaxis Epidermal and nail fragility Peripheral oedema Vulvovaginal candidiasis Paronychia, granulomatous lesions Bullous eruptions Reversible hair thinning and alopecia Myalgia and arthralgia Occasional nausea, headache, malaise, drowsiness Rhinitis, sweating, taste disturbance Stomatitis, cheilitis, and gingivitis Benign intracranial hypertension (2)

An increased risk of hepatitis has been reported to result from combined use of methotrexate and etretinate If given concurrently with phenytoin, the protein binding of phenytoin may be reduced. Acitretin and tetracyclines can cause increased intracranial pressure Concomitant administration of vitamin A and/or other oral retinoids with acitretin must be avoided because of the risk of hypervitaminosis A. (2)

Can alter glucose tolerance in diabetic patients Use with extreme caution in children Acitretin must not be used by women who are pregnant or may become pregnant while undergoing treatment or at any time for at least 3 years after treatment is discontinued (1,2)

Adult over 18 years (under expert supervision), initially 25–30 mg daily (darier’s disease 10 mg daily) for 2–4 weeks, then adjusted according to response, usual range 25–50 mg daily; up to 75 mg daily for short periods in psoriasis and ichthyosis (2,3)

1. Robertson DB, Maibach HI. Dermatologic Pharmacology. In Katzung BG, Masters SB, Trevor AJ, editors. Basic & Clinical Pharmacology. 12th ed. New York: McGraw Hill; 2012 p. 1061-80. 2. SORIATANE [Internet]. [cited 2013 Oct 28]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2004/19821s011lbl.pdf 3. British Medical Association and the Royal Pharmaceutical Society of Great Britain British National Formulary Issue 61. BMJ Publishing Group: UK; 2011