Update on retinoid therapy of psoriasis in: an update on the use of retinoids in dermatology

Abstract

Both in the topical and systemic treatment of psoriasis, retinoids are mainstays. In this chapter the history and modes of actions of retinoids are presented. Tazarotene and acitretin are the only retinoids that are available in both topical and systemic formulations. A more extensive description of their pharmacology, modes of action, indications and contraindications, clinical results, and treatment strategies will be presented. Finally, retinoid X receptor ligands and retinoic acid metabolism blocking agents will be introduced as potential future retinoid mimetics in psoriasis.

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

“…22,90 Severe hepatotoxic reactions resulting from retinoid use are rare, and reports include a severe cholestatic hepatitis occurring in a patient with a hypoplastic kidney, 11,96 and a severe hepatotoxic reaction with progression to liver cirrhosis. 90,97,98 However, data from 1877 patients receiving acitretin therapy showed overt chemical hepatitis in only 0AE26%.…”

“…15 A retrospective post hoc analysis of the data from three studies was published using the now more widely accepted criteria of the proportion of patients achieving at least 50% improvement in PASI (PASI 50) and at least 75% improvement (PASI 75 There is an impression from retrospective anecdotal studies that acitretin is more effective in erythrodermic 22 and pustular psoriasis than in chronic plaque psoriasis. 23 Etretinate was the most effective agent in one study of pustular psoriasis.…”

“…Blurred or decreased night vision has been reported occasionally. 22 Nausea has been reported infrequently. 22 Increased incidence of vulvovaginitis due to Candida albicans has been noted during treatment with acitretin.…”

“…22 Nausea has been reported infrequently. 22 Increased incidence of vulvovaginitis due to Candida albicans has been noted during treatment with acitretin. 117 Retinoids are associated with greater insulin sensitivity and could therefore induce hypoglycaemia in patients on antidiabetic medications.…”

Topical Therapies for Psoriasis

“…The mechanism of action of retinoids in psoriasis may include direct suppression of inflammation as well as inhibition of proliferation and normalization of differentiation in the epidermal layer (van de Kerkhof 2006). In the US topical retinoid for psoriasis is approved as tazarotene gel and cream (Tazorac  ) available in 0.05% and 0.1% formulations.…”