Low-Dose Acitretin Is Associated With Fewer Adverse Events Than High-Dose Acitretin in the Treatment of Psoriasis

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

“…18 Side-effects, like efficacy, were dose related. Pearce et al 19 reanalysed retrospectively the pivotal phase three trials and found that common adverse events were two to three times more frequent in patients receiving 50 mg daily compared with patients receiving 25 mg daily. On 25 mg daily changes in liver enzymes and lipids were minimal compared with higher doses.…”

An appraisal of oral retinoids in the treatment of pachyonychia congenita

“…This is in accordance with two previous studies, in which similar retinoid doses have been used for the treatment of various forms of ichthyoses and psoriasis, and no severe adverse effects were reported. 12,13 This study demonstrates a potential advantage of treatment with lower doses of acitretin for a longer duration compared with therapy with higher doses, shorter duration, and isotretinoin. Recently it was shown that in the treatment of patients with psoriasis low-dose acitretin (25 mg/d) was associated with fewer common adverse effects than high-dose acitretin (50 mg/d).…”

“…Recently it was shown that in the treatment of patients with psoriasis low-dose acitretin (25 mg/d) was associated with fewer common adverse effects than high-dose acitretin (50 mg/d). 13 Because lower doses may have a better risk/benefit ratio, it might be beneficial to begin treatment at a lower dose (eg, acitretin 10-25 mg/d) with further dose adjustments based on patient's response. Alternatively, treatment may be initiated at a higher dose and subsequently adjusted depending on pain and adverse effects.…”

“…For severe inherited disorders of cornification such as ichthyoses and psoriasis, oral retinoid therapy represents the treatment of choice. 12,13 In PC, this therapeutic approach is particularly attractive, because in screening assays, retinoids have been noted to suppress mutant keratin expression (W.H. Irwin McLean, DSc, FRSE, oral communication, May 2010).…”

Ustekinumab Induces Fast Response and Maintenance of Very Severe Refractory Scalp Psoriasis: Results in Two Greek Patients from the Psoriasis Hospital-Based Clinic

“…The use of the systemic retinoid acitretin in the treatment of severe psoriasis has been studied in general [33], but no specific use in the treatment of scalp lesions. Positive results are usually observed only after 24 weeks of treatment [34]. Acitretin has a limitation in the treatment of scalp psoriasis in that it may cause hair loss [2].…”