Acitretin

Acitretin, an aromatic retinoid, was used primarily for treating pustular psoriasis and psoriatic palmo-plantar keratoderma, and in combination with other therapies for other forms of psoriasis. It was also effective for cutaneous disorders of keratinization and severe cutaneous lichen planus. The mean effective dosage in adults was 35 to 40 mg daily. Acitretin helped prevent new skin carcinomas in predisposed patients. It had a terminal elimination half-life of 55 to 60 hours, but alcohol intake could extend this significantly. Due to its teratogenic effects, contraception was necessary during and for 2 years post-therapy. Side effects included mucocutaneous issues, elevated transaminases in 5 to 8% of patients, hyperlipidemia, and rare acute hepatotoxic reactions. Bony changes were also reported, and children's growth needed monitoring. Combining acitretin with hepatotoxic drugs or cyclines was contraindicated.