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American Academy of Dermatology Issues New Guidelines For the Management of Psoriasis With Systemic Medications
Date:6/4/2009

0 mg per day administered as a single dose.

"Typically, it takes three to six months for acitretin to achieve the desired response in most psoriasis patients," explained Dr. Pariser. "Appropriate dosing must take into account the balance among safety, tolerability and efficacy, as many patients may not be able to tolerate the higher dosages of acitretin needed for optimal efficacy."

Toxicities & Contraindications

Several potential adverse effects are associated with acitretin, such as alopecia, nausea and abdominal pain, and joint and muscle pain, to name a few. However, Dr. Pariser explained that these can generally be minimized by appropriate patient selection, careful dosing and monitoring. As is the case with methotrexate, acitretin's most serious side effect is its potential to cause birth defects. Therefore, its use is limited to male and female patients of non-childbearing potential. In addition, other increased risks include severely impaired liver or kidney function and chronic, abnormally elevated blood lipid values. For this reason, patients should be monitored with lipid profiles and liver enzymes once every two weeks after starting acitretin.

"These guidelines emphasize that the decision to prescribe methotrexate, cyclosporine, acitretin or any other traditional therapy must be individualized," said Dr. Pariser. "Under the right circumstances, systemic therapies can significantly improve even the more severe cases of psoriasis. But every patient needs to be carefully evaluated in terms of disease severity, quality of life, and general medical and psychological history. Dermatologists and patients must work together to continually review the response to treatment and potential risks."

To learn more about psoriasis, visit the PsoriasisNet section of www.skincarephysicians.com, a Web site dev
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SOURCE American Academy of Dermatology
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