Acitretin in dermatology

Abstract

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.

Acitretin as a Therapeutic Option for Chronic Hand Eczema

“…In addition, it also inhibits the production of keratinocyte-derived vascular endothelial growth factor5. Consequently, acitretin normalizes epidermal cell proliferation, differentiation, and cornification.…”

Late onset pityriasis rubra pilaris type IV treated with low-dose acitretin

“…These include alopecia, cheilitis or chapped lips, dermatitis, epistaxis, nail fragility, peeling rash, xerosis and pruritus, dryness of the eyes, which may result in discomfort, photophobia, blepharoconjunctivitis, and keratitis (9). In our case, the patient was treated with a low-dose regimen of acitretin, which was effective and well tolerated.…”

Severe ectropion in lamellar ichthyosis managed medically with oral acitretin

“…It inhibits cell growth and proliferation and decreases adenosine monophosphate‐dependent protein kinases in fibroblasts. Acitretin normalizes epidermal cell proliferation, differentiation, and cornification, leading to less epidermal hyperplasia . It also induces keratinocyte differentiation in epidermal layers and accelerates shedding of hyperkeratotic skin; inhibits production of vascular endothelial growth factor by keratinocytes; and has additional antiinflammatory, antineoplastic, and wound‐healing effects .…”

“…Acitretin normalizes epidermal cell proliferation, differentiation, and cornification, leading to less epidermal hyperplasia . It also induces keratinocyte differentiation in epidermal layers and accelerates shedding of hyperkeratotic skin; inhibits production of vascular endothelial growth factor by keratinocytes; and has additional antiinflammatory, antineoplastic, and wound‐healing effects . Overall, acitretin is a safer alternative to etretinate because of its shorter half‐life and better side‐effect profile …”