Unlike isotretinoin, acitretin (Soriatane) is not primarily sebosuppressive. Rather, it promotes normalization of dysregulated keratinocyte proliferative activity in the epidermis and is also antiinflammatory. Oral absorption is optimal when acitretin is taken with a fatty meal; peak levels are reached approximately 3 hours after ingestion, while steady-state plasma levels are achieved after approximately 3 weeks of daily dosing. The mean terminal elimination half-life of the parent compound is 49 hours. However, when consumed with ethanol, acitretin may be transesterified to form etretinate, a retinoid that is stored in adipose tissue, resulting in a much longer half-life (3-4 months or longer).
Acitretin is most useful for the treatment of severe psoriasis, particularly the pustular and erythrodermic variants. Psoriatic nail changes and arthritis also may respond. Combining the drug with ultraviolet light therapy (Re-UVB, in the case of ultraviolet B radiation, or Re-PUVA, with psoralen plus ultraviolet A radiation) permits the use of lower doses of both acitretin and ultraviolet radiation. Other conditions for which the drug may be especially useful include congenital and acquired hyperkeratotic disorders, such as the ichthyoses and palmoplantar keratodermas, and severe lichen planus.
Like other systemic retinoids, acitretin is a serious teratogen and should not be prescribed for women of childbearing potential unless no acceptable alternative is available and the patient has acknowledged in writing that she understands the need to use two effective forms of contraception during therapy and for 3 years following discontinuation of therapy. Because of the much longer half-life of etretinate, which may be formed when ethanol is ingested with acitretin, female patients of childbearing potential must also agree not to ingest alcohol during treatment and for 2 months following its discontinuation. Other toxicities are similar to those of isotretinoin; they include cutaneous irritation and inflammation, bone and joint pain, hyperlipi-demia, hepatic enzyme elevation, and tendinous and ligamentous calcifications. Alopecia (hair loss) may also occur in some patients.
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