Acitretin adverse effects

Sulfasalazine is an antiinflammatory agent that inhibits 5-lipoxygenase. It is used selectively as an alternative treatment, particularly in patients with concurrent psoriatic arthritis. When used alone, it is not as effective as methotrexate, PUVA, or acitretin. However, it has a relatively high margin of safety. The usual oral dose is 3 to 4 g/day for 8 weeks. Its adverse effects are similar to other sulfonamide antibiotics. 

Acitretin (Soriatane), a metabolite of the aromatic retinoid etretinate, is quite effective in the treatment of psoriasis, especially pustular forms. It is given orally at a dosage of 25-50 mg/d. Adverse effects attributable to acitretin therapy are similar to those seen with isotretinoin and resemble hypervitaminosis A. Elevations in cholesterol and triglycerides may be noted with acitretin, and hepatotoxicity with liver enzyme elevations has been reported. Acitretin is more teratogenic than isotretinoin in the animal species studied to date, which is of special concern in view of the drug s prolonged elimination time (more than 3 months) after chronic administration. In cases where etretinate is formed by concomitant administration of acitretin and ethanol, etretinate may be found in plasma and subcutaneous fat for many years. 

Hepatomegaly is an adverse effect of retinol and tretinoin. Transient slight rises in liver enzymes, notably aspartate transaminase, alanine transaminase, and alkaline phosphatase, are common, but some cases of hepato-toxicity due to etretinate and acitretin (SEDA-20, 154) have also been reported (76), as has cholestatic jaundice due to etretinate (77). Etretinate may have played a role in a case of liver failure leading to death (76). 

Acitretin is indicated for the treatment of severe psoriasis. The initial dose is 25 to SO mg in a single dase with food. Because of.significant variation in pharmacokinetics and efficacy. however, the maintenance dose should be individualized. Initial response may occur in 2 weeks, but maximal response requires 2 to 5 months. Because of significant adverse effects a.ssociaied with its use. acitretin should be reserved for patients who do nut respond to other therapies or whose clinical condition contraindicates the use of other treatments. 

Acitretin, an oral retinoid, is the active metabolite of etretinate and has demonstrated clinical effects similar to etretinate, but with fewer adverse effects. Acitretin is indicated for the treatment of severe psoriasis, including erythrodermic and generalized pustular types, but is more useful as an adjunct in the treatment of plaque psoriasis. In contrast to the fast-acting cyclosporine and methotrexate, acitretin resolves psoriatic lesions more slowly. 

Acitretin has shown good results when combined with other psoriatic therapies, including PUVA and UVB, cyclosporine, and methotrexate. The combination of acitretin and PUVA is highly effective and provides faster and more complete clearance, as well as allowing a decrease in the doses of both agents, thereby limiting the risk of adverse effects. ... 

Katz HI, Waalen J, Leach EE. Acitretin in psoriasis an overview of adverse effects. J Am Acad Dermatol 1999 41 S7-S12. 

Side effects of acitretin include dryness of mucous membranes and skin with localized exfoliation of the palms and plantar surface of the feet, skin and nail erosion and transient thinning of hair. These effects are dose-dependent and reversible. Longer-term adverse effects include ossification of ligaments and raised plasma triglycerides and cholesterol levels. Acitretin should not be taken in combination with methotrexate because of toxicity to the liver. 

In addition to their adverse effects on the skin barrier properties, surfactants also are used to enhance the penetration of active ingredients into the skin [149]. When used in this fashion, the surfactant is known as a penetration enhancer. Of the three classes of surfactants, the nonionics, because of their low irritancy potential, have received the most attention. However, Maibach and co-workers [150,151] have investigated the effects of sodium lauryl sulfate on the percutaneous absorption of hydrocortisone, indomethacin, ibuprofen, and acitretin. 

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