Section : Notes de congrès/conférences

Therapy with Oral Acitretin (a vitamin A derivative)


  • is a metabolite of etretinate
  • is FDA-approved for use in psoriasis
  • is less lipophilic than the former and fat storage (half life 120 days):
    • It is highly highly toxic to embryos during pregnancies (teratogenic) and contraception in women must be used for at least 2 years (come say 3 three years)
    • no safe dosage: it remains teratogenic at any dose.
  • Tip: do not use in women of childbearing age except if there is a history of skin cancers following organ transplant
  • the frequent side effects include:
    • dry skin (xerosis)
    • alopecia: telogen effluvium is seen at doses if 25mg and upwards
  • no use giving it it women with childbearing  except if history of cancers following transplant
  • Uses:
    • pustular psoriasis
    • plaque psoriasis: when combined with phototherapy (UVB or PUVA) it speeds up response and can be used at lower doses
    • palm psoriasis
    • pediatric psoriasis: off-label tiny 10mg dosage every 4 days: growth problems* not observed (parents are afraid to use biologics in this group)*retinoids can cause premature closure of the epiyphses
    • Its most useful usage according to the presenter is « off label »:
      • PRP (Pityriasis Rubra Pilaris)
        • acitretin is useful especially in the inherited kind
        • biologics are more effective in acquired PRP
      • keratinizing disorders (Darier’s, keratodermas…)
      • other:
        • chemoprevention of skin cancers:
          • Muir Torre Syndrome: 10-40mg per day to suppress sebaceous carcinomas
          • immunosuppression-induced increases incidence of skin cancers
            • 25mg indicated but 10mg enough in author’s experience
            • reduces SCC (Squamous Cell Carcinoma) from appearing and its malignant behavior


Dr Christophe HSU – dermatologist. Geneva, Switzerland

S002 – Jackson JM et al. Systemic Therapies for Dermatologists: a Comprehensive Review and Update

AAD 2015 Annual Meeting, San Francisco CA – United States