Acitretin

Arch Dermatol. 1997 Jun;133(6):711-5.

Acitretin therapy is effective for psoriasis associated with human immunodeficiency virus infection.[Pubmed: 9197824]

The Psoriasis Area and Severity Index was used to assess the clinical response to treatment.
METHODS AND RESULTS:
To monitor for toxic drug effects, a panel of laboratory parameters, including complete blood cell count, biochemistry profile, urinalysis, HLA typing, skin biopsy for histological examination, and T-cell counts, was performed. Six (54%) of 11 patients with PS-HIV achieved good to excellent responses using Acitretin monotherapy. Four patients (36%) achieved complete clearing. There was no evidence of a correlation between the pretreatment measures of immunosuppression and the therapeutic response. Parameters of immunosuppression were not exacerbated by Acitretin therapy.
CONCLUSIONS:
Acitretin is a safe and effective treatment for PS-HIV. Both skin and joint manifestations of PS-HIV responded to Acitretin therapy in most patients. Optimal results were achieved with a dose of 75 mg/d. The adverse effects were moderate and well tolerated. Acitretin does not appear to have immunosuppressive properties. A formal randomized clinical trial is warranted.

Australas J Dermatol. 2002 Nov;43(4):269-73.

Acitretin for chemoprevention of non-melanoma skin cancers in renal transplant recipients.[Pubmed: 12423433]

A prospective, open randomized crossover trial was conducted to evaluate the efficacy of Acitretin for chemoprevention of squamous cell carcinomas and basal cell carcinomas in renal allograft recipients.
METHODS AND RESULTS:
Analysis was performed according to the intention-to treat principle. Twenty-three patients with previous history of non-melanoma skin cancer enrolled into the study and were randomly allocated into two groups. They crossed over at the end of 1 year. Eleven (47.8%) patients completed the 2-year trial. Twelve (52.2%) patients withdrew from the trial. Nine of these withdrew because of side-effects of Acitretin. The majority of the patients who continued with the Acitretin could tolerate 25 mg of Acitretin daily or on alternate days.
CONCLUSIONS:
The number of squamous cell carcinomas (SCC) observed in patients while on Acitretin was significantly lower than that in the drug-free period (P = 0.002). A similar trend was observed in patients with basal cell carcinomas, but this was not significant and the numbers were small. Side-effects were a major limiting factor. A severe rebound increase in SCC occurred in one patient after the Acitretin was ceased.

Arch Dermatol. 1990 Apr;126(4):482-6.

Efficiency of acitretin in combination with UV-B in the treatment of severe psoriasis.[Pubmed: 2138875]

Compared with the antipsoriatic retinoid etretinate, the new aromatic retinoid Acitretin represents an important advance due to its rapid elimination kinetics.
METHODS AND RESULTS:
Since in psoriasis vulgaris retinoids are used predominantly in combination regimens, we investigated the therapeutic efficacy of Acitretin and UV-B compared with placebo and UV-B in a double-blind, randomized multicenter trial in 82 patients with severe psoriasis. They were treated with 35 mg of the study medication during the first 4 weeks of therapy and 25 mg thereafter, concomitantly with UV-B irradiation in increasing energy doses. Forty patients who underwent therapy with Acitretin and UV-B and 38 patients who underwent therapy with placebo and UV-B were evaluated for efficacy. The target variables--psoriasis severity index and total UV-B dose--were reported at intervals of 2 weeks over a maximum period of 8 weeks. At the end of treatment, the psoriasis severity index decrease was 79% in the Acitretin and UV-B group and 35% in the placebo and UV-B group. The response rate, defined as greater than or equal to a 75% decrease of the psoriasis severity index, was 60% for the combination treatment and only 24% for the control treatment. This treatment response was achieved with markedly lower cumulative UV-B energy. The median cumulative UV-B energy applied to reach 75% clinical improvement was 11.8 J/cm2 vs 6.9 J/cm2. Side effects showed a similar pattern in both groups. Our data show that the Acitretin dramatically improves the results of UV-B treatment in patients with severe psoriasis. In addition, it markedly decreases the effective cumulative UV-B dose, thereby reducing the potential long-term hazards of UV irradiation.
CONCLUSIONS:
We conclude that the Acitretin plus UV-B combination treatment represents a highly effective therapeutic regimen in severe psoriasis.

J Am Acad Dermatol. 1994 Feb;30(2 Pt 1):225-31.

Acitretin in the treatment of severe lichen sclerosus et atrophicus of the vulva: a double-blind, placebo-controlled study.[Pubmed: 8288782]

Promising results have been reported from treatment with oral retinoids in patients with severe lichen sclerosus et atrophicus (LSA) of the vulva.The aim of our study was to determine the efficacy of Acitretin (20 to 30 mg/day) for 16 weeks in LSA.
METHODS AND RESULTS:
Seventy-eight patients were enrolled into a multicenter, randomized, placebo-controlled, double-blind trial. The primary measure of efficacy was the "responder" rate based on the assessment of characteristic clinical features of LSA of the vulva (pruritus, burning, atrophy, hyperkeratosis, and secondary features such as erosions, ulcers, edema, or lichenification) and on the extent of the lesions. From the 46 patients eligible for efficacy analysis, a significantly higher number of responders was observed in the Acitretin-treatment group (14 of 22 patients) as compared with the placebo-treatment group (6 of 24 patients). Typical retinoid adverse reactions were observed in all patients receiving active drug.
CONCLUSIONS:
Acitretin is effective in treating women with severe LSA of the vulva.

Clin Transplant. 2005 Feb;19(1):115-21.

Acitretin and skin cancer in kidney transplanted patients. Clinical and histological evaluation and immunohistochemical analysis of lymphocytes, natural killer cells and Langerhans' cells in sun exposed and sun protected skin.[Pubmed: 15659144]

Renal transplanted recipients have an increased incidence of actinic keratosis and skin cancer.
METHODS AND RESULTS:
In order to examine the chemoprophylatic effects of low-dose Acitretin on keratosis and skin cancer development we submitted 13 renal transplanted patients who presented actinic keratosis to Acitretin therapy (20 mg/d) for 12 months. The patients were assessed at monthly intervals during the first 6 months and every 2 months until the 12th month for new skin lesions and for Acitretin toxicity. Normal skin biopsies of sun exposed and sun protected areas were taken for histopathological examination and submitted to immunohistochemistry technique to demonstrate CD4+ and CD8+ T lymphocytes, natural killer (NK) cells and Langerhans' cells which were counted and compared before, after 6 and 12 months of the treatment. There was an improvement of actinic keratosis in all patients. Only one patient developed new skin cancer. Side-effects were well tolerated and no significant biochemical effects were observed. There were no differences in the microscopic aspects of the skin and in the number of CD4+ and CD8+ T lymphocytes and NK cells. There was a significant increase in the number of epidermal Langerhans' cells after 12 months of Acitretin therapy.
CONCLUSIONS:
The data obtained permit us to conclude that low dose Acitretin therapy is safe, well tolerated and partially effective in chemoprophylaxis of skin cancer in renal transplant recipients. The increase in epidermal Langerhans' cells observed may be an expression of the immunomodulatory effect of Acitretin.