Acitretin, the principal and free
acid metabolite of
etretinate, was used to treat patients with stable, plaque-type
psoriasis. For the first 8 weeks, 38 patients received placebo or
acitretin, 10, 25, 50, or 75 mg daily, in a double-blind manner. After the double-blind phase, the patients were allowed to continue for a total of 6 months of
acitretin therapy at an average dosage of 50 mg/day. When the patients flared after stopping
therapy, an additional 6-month course of
acitretin therapy was offered.
Acitretin, which was as effective as
etretinate, had to be given at a dosage of 50 mg/day or more to obtain a significant benefit. Side effects frequently occurred in patients receiving
acitretin, 25 mg/day or more, but were generally mild and did not warrant discontinuation of
therapy. They were similar to those of
etretinate therapy;
cheilitis, peeling of palms and soles, and
alopecia occurred most frequently. The most common abnormal laboratory test results were elevations in serum
triglycerides and, to a lesser extent, serum
cholesterol and liver
transaminase levels.
Acitretin, in view of its much shorter half-life and similar efficacy and side-effect profile compared with
etretinate, may be a preferable
therapy for
psoriasis, especially in women of childbearing age.