Retinoids are effective systemic agents in the treatment of psoriasis. Acitretin, a synthetic aromatic derivative of retinoic acid, has replaced etretinate in retinoid therapy of psoriasis because of its more favorable pharmacokinetic profile, including a significantly shorter half-life. Most of the adverse effects associated with acitretin are teratogenicity, hepatotoxicity, pseudotumor cerebri, pancreatitis, hyperlipidemia, hyperostosis, and mucocutaneous side effects. There are two reports worldwide describing patients who developed acute respiratory distress syndrome associated with acitretin. This suggests the possibility of serious lung complications associated with acitretin. We report a case of a 61-year-old man who developed interstitial pneumonitis that might have been induced by acitretin during the treatment of pustular psoriasis. In these cases, immediate withdrawal of retinoic acid is necessary, and corticosteroid therapy should be considered.
Acitretin ; Etretinate ; Half-Life ; Humans ; Hyperlipidemias ; Hyperostosis ; Lung ; Lung Diseases, Interstitial ; Middle Aged ; Pancreatitis ; Pseudotumor Cerebri ; Psoriasis ; Respiratory Distress Syndrome, Adult ; Retinoids ; Tretinoin

Impetigo herpetiformis is a rare, severe dermatologic disorder that is similar to a type of pustular psoriasis that predominantly occurs during the 3rd trimester of pregnancy. This condition usually resolves after delivery and it rarely continues until the postpartum period. Systemic corticosteroids have proven to be the drug of choice for the management of impetigo herpetiformis. In the postpartum period, oral retinoids such as isotretinoin, etretinate and acitretin can be used to control impetigo herpetiformis, but their side effect such as teratogenicity is a big issue to women of child-bearing age. We report here on a case of impetigo herpetiformis in a 28-year-old woman who did not respond to oral corticosteroids, but she was treated successfully with cyclosporine. To the best of our knowledge this is the first case of impetigo herpetiformis treated with cyclosporine in the Korean medical literature.
Acitretin ; Adrenal Cortex Hormones ; Adult ; Cyclosporine ; Etretinate ; Female ; Humans ; Impetigo ; Isotretinoin ; Postpartum Period ; Pregnancy ; Psoriasis ; Retinoids

Impetigo herpetiformis is a rare and severe pustular disorder which primarily occurs in pregnancy. Etretinate and acitretin are effective in impetigo herpetiformis with systemic steroid. A major concern with the use of systemic retinoids is their high teratogenic potential. Isotretinoin is another retinoid but its teratogenic potential lasts only for two months. Hence, isotretinoin may be used to treat women of childbearing years with impetigo herpetiformis. We report a case of impetigo herpetiformis in a 26-year-old woman whose condition was improved with isotretinoin.
Acitretin ; Adult ; Etretinate ; Female ; Humans ; Impetigo ; Isotretinoin ; Pregnancy ; Retinoids

Porokeratosis is a disorder of epidermal keratinization that is histologically characterized by the presence of cornoid lamella. Many treatment modalities have been used, such as, surgical excision, cryosurgery, CO2 laser, oral etretinate, topical 5-fluorouracil and keratolytics. However, universal treatment guidelines have never been established. We tried 5% imiquimod cream on three patients who have porokeratosis of Mibelli which are intractable to other previous treatment modalities. Two of them showed a marked and moderate improvement, respectively. But the third patient exhibited only slight response. Herein we report our treatment experience and review the related literature.
Acitretin ; Cryosurgery ; Etretinate ; Fluorouracil ; Humans ; Lasers, Gas ; Porokeratosis*

Vesiculobullous Darier's disease is a rare variant of Darier's disease which is characterized by vesicles and bullae, usually distributed on the sun-exposed areas of the body. Blistering may be percipitated by factors such as high humidity, ultraviolet radiation, etretinate treatment, surgery or physical stress. Widespread vesiculation or bullous lesions are unusual in the absence of cutaneous bacterial or viral infections. Herein, we report an unusual case of vesiculobullous Darier's disease which developed on the scalp in a 25-year-old man.
Acitretin ; Adult ; Blister ; Darier Disease ; Etretinate ; Humans ; Humidity ; Scalp

Generalized pustular psoriasis is a lethal variant of psoriasis characterized by the appearance of sterile pustules on psoriatic skin. Etretinate and acitretin are effective in pustular forms of psoriasis, including generalized pustular psoriasis. A major concern with the use of systemic retinoid is their high teratogenic potential. Since etretinate and acitretin are remetabolized into long-lived compounds, isotretinoin may be used to treat women of childbearing years with generalized pustular psoriasis. We report a case of generalized pustular psoriasis in a 28-year-old woman whose condition was improved with isotretinoin. Clinical improvement was noted with the administration of isotretinoin at the dose of 30mg/day.
Acitretin ; Adult ; Etretinate ; Female ; Humans ; Isotretinoin* ; Psoriasis* ; Skin

Keratoacanthoma is a benign epithelial growth tumor arising from the hair follicle predominantly in elderly patients on sun-exposed skin. Intralesional therapy with 5-fluorouracil is a safe treatment and may be the treatment of choice for multiple keratoacanthoma and solitary lesion which are difficult to remove surgically. We have experienced a case of multiple keratoacanthoma which involved the right nasolabial fold and the left ear. We treated them with oral etretinate and intralesional 5-fluorouracil(5-FU), therefore minimized the scar of the lesion and the possibility of recurrence.
Acitretin* ; Aged ; Cicatrix ; Ear ; Etretinate* ; Fluorouracil* ; Hair Follicle ; Humans ; Keratoacanthoma* ; Nasolabial Fold ; Recurrence ; Skin

BACKGROUND: Although retinoid and PUVA monotherapy is effective for psoriasis, both treatment regimens have some limitations because of the risk of long-term toxicity. OBJECTIVE: We performed Re-PUVA combination therapy to evaluate the clinical efficacy and safety in comparison with retinoid and PUVA monotherapy. METHODS: Seventy-eight psoriasis patients received Re-PUVA combination therapy as well as conventional retinoid and PUVA monotherapy. Pretreatment with etretinate for 1 week was followed by PUVA therapy in combination with etretinate. RESULTS: 1. Among patients who received Re-PUVA combination therapy, clearing was shown in 77.3% and improvement in 13.6%, which were higher than retinoid, 27.8%/61.1%, and PUVA monotherapy, 65.8%/21.0%.2. In patients who reached grade 4 with Re-PUVA therapy, the duration and total dose of etretinate were 56.4 days and 1616mg. These were significantly lower than retinoid monotherapy, 107.5 days and 2577.5mg.3. In patients who reached grade 4 with Re-PUVA therapy, the number and total dose of UVA were 13.3 and 82.8 J/cm2, which showed no difference compared with those of PUVA monotherapy, 16.2 and 120.2 J/cm2. However, excluding the cases who did not respond to previous monotherapy, the number and total dose of UVA in Re-PUVA were 10.4 and 49.0J/cm2, which were significantly lower than those of PUVA4. The side effects of Re-PUVA were reported in 54.5%, which were similar to PUVA monotherapy, 52.6%, and lower than retinoid monotherapy, 83.3%. There were some side effects of retinoid, such as cheilitis, dry mouth, elevation of sGOT/sGPT and triglycerides, and side effects of PUVA, such as itching, erythema, anorexia, nausea and vomiting. CONCLUSION: Our study suggests that Re-PUVA combination therapy is more effective and tolerable than retinoid and PUVA monotherapy in the treatment of psoriasis, especially in severe and recalcitrant cases.
Acitretin ; Anorexia ; Cheilitis ; Erythema ; Etretinate ; Humans ; Mouth ; Nausea ; Pruritus ; Psoriasis* ; PUVA Therapy ; Triglycerides ; Vomiting

We report a case of Darier's disease with typical cutaneous and nail lesions in a 50-year-old male patient. He has brownish hyperkeratotic papules on the ant.chest, back, both axilla and groins and verrucous surfaced hypertrophic plaques on the scalp, forehead and both postauricular areas, which were accompanied by a severe itching sensation and malodor. Also he has finger nail lesions such as subungual hyperkeratotic papules, distal wedge shaped notching and multiple longitudinal red lines on the nail plates. Histopathologic features taken from the inguinal area revealed hyperkeratosis, suprabasal clefts and lacuna, protruded villi lined with one layer of basal cells into the cavity and dyskeratotic cells such as corps ronds in the epidermis. Hyperkeratotic papules on the ant.chest, back, both axilla and groins disappeared after systemic treatment withe a low dose of oral etretinate but hypertrophic plaques on the scalp and both postauricular areas still remained clinically and histopathologically. We then the treated postauricular hypertrophic plaques with CO2 laser vaporization and severe malodor with oral isotretinoin and it resulted in a marked improvement.
Acitretin* ; Axilla ; Darier Disease* ; Epidermis ; Etretinate* ; Fingers ; Forehead ; Groin ; Humans ; Isotretinoin* ; Lasers, Gas* ; Male ; Middle Aged ; Pruritus ; Scalp ; Sensation ; Volatilization*

We present a case of generalized pustular psoriasis in a 47-year-old female who was treated with cyclosporine and methotrexate. She developed generalized pustular eruptions after irregular therapy of steroid and etretinate for severe psoriasis. Treatment with cyclosporine and a steroid supplement produced much improvement, but during the tapering of cyclosporine there was aggravation with pusutules and fever. She was placed on methotrexate therapy. The pustules and erythema began to remit, and eventual clearing of the skin lesions was achieved in 4 months after introduction of methotrexate.
Acitretin ; Cyclosporine ; Erythema ; Etretinate ; Female ; Fever ; Humans ; Methotrexate ; Middle Aged ; Psoriasis* ; Skin