The treatment of psoriasis with etretinate and acitretin: a follow up of actual use

The present study is a retrospective search on the actual use of systemic r etinoids in the treatment of psoriasis. The design of the study was inclusi on 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 fol low up. In total 94 patients were included, who were treated with etretinat e or acitretin, out of a cohort of 2,000 patients with psoriasis at the Nij megen Department of Dermatology. The majority of the patients were older th an 40 years, 31% were suffering from pustular psoriasis, 6% from erythroder mic psoriasis and 17% from psoriasis arthropatica. Most patients had had ps oriasis for more than 5 years and in 56% of them retinoids were the first s ystemic 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, 2 5% of them were included again for acitretin treatment. Therefore, prolonge d treatment actually had occurred in approximately half of the patients. In contrast to the common belief, erythrodermic psoriasis proved to be not th e typically "low-dose" - and pustular psoriasis was not the typically "high dose" indication. The present study, however, reconfirmed the high efficac y of systemic retinoids in pustular- and erythrodermic psoriasis. It was al so reconfirmed that systemic retinoids are not effective in arthropathic ps oriasis. The occurrence of side effects largely followed the controlled inv estigations. At least 10 years' follow up had not revealed serious side eff ects. In those patients (n = 30) who completed the entire survey in the Nij megen centre 19 patients were treated with at least one course of photo(che mo)therapy and 9 patients were treated subsequently with methotrexate.