Acitretin, a metabolite of
etretinate, was given to 38 patients for the treatment of
psoriasis. During the first 8 weeks patients received either placebo, 10 mg, 25 mg, 50 mg, or 75 mg of
acitretin daily in a double-blind manner. The dosages of 10 mg and 25 mg daily did not achieve any statistically significant improvement in
psoriasis over placebo; however, both the 50 and 75 mg dosages were statistically significantly better than placebo. Side effects were primarily mucocutaneous and occurred in most patients receiving 25 mg or more of
acitretin daily. After the double-blind period, patients continued treatment in an open fashion until they had received a total of 24 weeks of
acitretin therapy. Most patients received 50 mg of
acitretin daily, which adequately cleared their
psoriasis. After approximately 3 months without
acitretin, most patients required
retreatment. Subsequent 24-week courses of
therapy were generally effective and well tolerated. The most common laboratory abnormalities were elevations of
triglyceride,
cholesterol, and liver
transaminase levels. The efficacy and side effects of
acitretin appear to be similar to those of
etretinate; the principal advantage of
acitretin is its shorter half-life. Although
acitretin is a potent
teratogen, its rapid elimination makes it a viable treatment for
psoriasis among women of childbearing potential.