Retinoids in treatment of psoriasis

Topical retinoid treatment:

• tazarotene (available in 0.05% & 0.1% gels or creams) is a topical retinoid licensed for the treatment of psoriasis
• it has a relatively low efficacy
• may cause soreness and burning
• should not be used in pregnancy
• as with other topical therapies, combination therapy has been tried, eg combining tazarotene with a topical corticosteroid increased efficacy while reducing the incidence of local adverse effects (1)

Oral retinoid therapy:

• Requires dermatologist supervision
  • Acitretin is an effective oral retinoid as a monotherapy
  • long term therapy may be necessary since retinoids only suppresses the disease process
  • retinoids are potent antipsoriatic drugs for pustular and erythrodermic psoriasis but are less effective in chronic plaque psoriasis
  • when used in combination with PUVA it has been shown to reduce the required dosage (both UVA and acitretin) to achieve clearance
  • side effects - drying and cracking of lips, dryness of the nasal buccal and conjunctival mucosa, elevation of liver enzymes (20-30%) and plasma lipid levels (up to 25%)
  • due to the teratogenicity of the drug it should be avoided in pregnancy and patients should be advised not to get pregnant for a period of 2 years after stopping acitretin (3)

Consult the summary of product characteristics before prescribing this drug.

Reference:

• 1. Lebwohi M et al. Psoriatic arthritis and psoriasis: treatment. Annals of the Rheumatic Diseases 2005; 64:ii83-ii86
• 2. Prescriber (2005); 16(8).
• 3. The British Association of Dermatologists. General management of Psoriasis - Oral retinoids
• 4. Update (8/7/99), 34-44.