British Association of Dermatologists guidelines on the efficacy and use of acitretin in dermatology

Ormerod, Anthony; Campalani, Emanuela; Goodfield, M. J. D.

doi:10.1111/j.1365-2133.2010.09755.x

Cited by 126 publications

(168 citation statements)

References 118 publications

(118 reference statements)

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“…Although acitretin has relatively low efficacy and is poorly tolerated because of numerous side effects, including mucocutaneous dryness (the extent of which frequently limits dosing), hyperlipidemia, and teratogenicity, 37 it has a place as either monotherapy or in combination with phototherapy, in the treatment of a subset of patients with severe disease. There is limited pharmacogenomic work for this therapeutic agent, but polymorphisms of the apolipoprotein E gene (APOE) and the vascular endothelial growth factor gene (VEGF) have been evaluated as predictors of response to psoriasis patients treated with acitretin.…”

Section: Acitretinmentioning

confidence: 99%

Pharmacogenomics and the Resulting Impact on Psoriasis Therapies

Foulkes

Warren²

2015

Dermatologic Clinics

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Section: Acitretinmentioning

confidence: 99%

Pharmacogenomics and the Resulting Impact on Psoriasis Therapies

Foulkes

Warren²

2015

Dermatologic Clinics

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“…Monitoring of liver function test for at least 3months is recommended in these patients. 9 Acitretin should be disinterested, in the case of toxic hepatic injury during treatment and further examination should be considered. 8 Hepatotoxicity as a proved adverse effect of acitretin has been reviewed in some studies.…”

Section: Discussionmentioning

confidence: 99%

Severe Hepatotoxic Injury and Cirrhosis Due to Acitretin

Mokhtare¹

2017

JLRDT

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We report a case of 48year old man presented with icter, itching and nausea and vomiting. He had developed a severe hepatotoxic reaction, after treatment with acitretin (oral retinoid, which is the derivative of etretinate). Histological findings showed the development of liver fibrosis and cirrhosis. Elevated serum aminotransferase levels, which are usually reversible, have been reported during treatment with acitretin, however; the present study indicates a warning message that severe hepatotoxic injury may follow this treatment. Ab, HCV Ab, HIV Ab1, 2, Anti HSV Ab, Anti EBV Ab, Anti VZV Ab, Anti CMV Ab) with negative results and the other laboratory investigations such as; Antinuclear Ab, ASMA, Anti-LKM Ab, serum protein electerophoresis, Ferritin, Anti-mitochondrial Ab, P-ANCA, ASCA, IgG4, TSH, Anti-tissue transglutaminase IgG and IgA Ab) with normal range results. LDH and liver enzyme were decreased during hospital course without any significant change in ALP and Bilirubin level. KeywordsUpper endoscopy was done with normal results. Magnetic Resonance Cholangiopancreatography (MRCP) was done with the result of periportal and pericholecystic edema and decreased intrahepatic bile ducts diameter due to parenchymal hepatic edema. The other parts were normal according to the report (Figure 1). Figure 1Periportal and pericholecystic edema were found, the diameter of intrahepatic bile ducts was less than normal and pruned that could be due to parenchymal hepatic edema.Finally, liver biopsy was done .The sample was stained with Hematoxylin, and Eosin, Trichrome and Reticulin. Extensive lobular architecture disarray with marked necro-inflammatory changes of parenchyma characterized by obvious hydropic changes and single cell necrosis of hepatocytes as well as infiltration of mixed inflammatory cells was shown in Hematoxylin, and Eosin staining (Figure 2). Collapse of reticulin network associated with psuedolobule formation as well as portal fibrosis was shown in Reticulin and MassonTrichrome staining (Figure 3,4). Overall findings were in favor of an acute/sub acute liver injury according to Modified HAI score grade: 14/18, stage: 3/6. The patient with the diagnosis of acitretin induced cirrhosis was referred to liver transplantation clinic. After one week admission course the patient was discharged with relative symptome relief and was requested for monthly follow-up .Five months later in monthly follow-up visit ,these data was found; AST=31U/L(12- Liver fibroscan (Fibroscan model 502 touch, Echosence France, Paris) was done 5months later that revealed fibrosis score of F3 (10.1kPa) based on metavir histological index, and steatosis score of 332 (dB/m) which is equal to 80% steatosis, S3 stage. We followed the patient for 9months without any change in general clinical condition and liver function tests. DiscussionThe American Academy of Dermatology suggests a protocol for monitoring of these patients, as follows: CBC and renal function tests (baseline and then every 12weeks); lipid profile BS in diabetic p...

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“…Cuando se requiere tratamiento prolongado con retinoides se deben monitorizar los parámetros de crecimiento y desarrollo óseo. Aunque algunos autores proponen realizar un estudio óseo previo y un seguimiento anual 151 , las guías más recientes no recomiendan la realización de radiografías rutinarias por sus potenciales efectos dañinos 152 . Solo en el caso de que el paciente presente dolores musculoesqueléticos atípicos se recomienda realizar radiografías selectivas 152 .…”

Section: Tratamiento Sistémicounclassified