The present study is a retrospective search on the actual use of systemic
retinoids in the treatment of
psoriasis. The design of the study was inclusion of the patients in whom
retinoid treatment was initiated from 1981 up to 1989. The analysis was carried out in 1999, after at least 10 years of follow up. In total 94 patients were included, who were treated with
etretinate or
acitretin, out of a cohort of 2,000 patients with
psoriasis at the Nijmegen Department of Dermatology. The majority of the patients were older than 40 years, 31% were suffering from pustular
psoriasis, 6% from erythrodermic
psoriasis and 17% from
psoriasis arthropatica. Most patients had had
psoriasis for more than 5 years and in 56% of them
retinoids were the first systemic treatment. Continuous treatment for more than one year was recorded in 33% of the patients. During long-term follow up of at least 10 years, 25% of them were included again for
acitretin treatment. Therefore, prolonged treatment actually had occurred in approximately half of the patients. In contrast to the common belief, erythrodermic
psoriasis proved to be not the typically "low-dose" - and pustular
psoriasis was not the typically "high dose" indication. The present study, however, reconfirmed the high efficacy of systemic
retinoids in pustular- and erythrodermic
psoriasis. It was also reconfirmed that systemic
retinoids are not effective in arthropathic
psoriasis. The occurrence of side effects largely followed the controlled investigations. At least 10 years' follow up had not revealed serious side effects. In those patients (
n = 30) who completed the entire survey in the Nijmegen centre 19 patients were treated with at least one course of photo(chemo)
therapy and 9 patients were treated subsequently with
methotrexate.