Journal of the American Academy of Dermatology
Acitretin in combination with UVB or PUVA☆,☆☆,★,★★
Section snippets
ACITRETIN AND UVB
In combination with UVB, acitretin may be used in doses of 10 to 25 mg/day. At these relatively low doses, side effects such as hair loss, cheilitis, and minor musculoskeletal complaints occur less frequently. Typically with use of this combination, low-dose acitretin is started as a single agent for 2 weeks. UVB treatments are then added to the regimen, and the combination is continued for at least 4 more weeks. Because acitretin, like other retinoids, can cause thinning of the stratum
ACITRETIN AND PUVA
In combination with PUVA, as with UVB, acitretin may be used in relatively low doses of 10 to 25 mg/day. UVA doses are decreased by 50%, but a standard dose of psoralen is used. Acitretin is started 1 to 2 weeks before initiation of PUVA treatment.
In one randomized, double-blind trial, the acitretin–PUVA combination resulted in remission in 89% of patients after 8 weeks and 94% after 12 weeks compared with a remission rate of 35% at 8 weeks and 80% at 12 weeks in patients treated with
PALMOPLANTAR PUSTULAR PSORIASIS
The combination of PUVA and acitretin has proven effective in cases in which monotherapy with either agent has failed. One particularly challenging form of psoriasis often refractory to monotherapy is pustular psoriasis of the palms and soles. In the case of palmoplantar pustular psoriasis shown in Fig 1, the patient had been treated with PUVA therapy alone for 3 months with little improvement.
CONCLUSION
Acitretin used in combination with phototherapy with UVB or PUVA in the treatment of psoriasis allows lower doses of both modalities to be used, resulting in fewer side effects. In these combinations, acitretin is used in doses of 10 to 25 mg/day and is generally started 1 to 2 weeks before initiation of phototherapy. Doses of UVB or UVA should be reduced by 50% and fewer phototherapy visits are typically required. In many cases, the combination is more effective than either phototherapy or
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Cited by (79)
Role of phototherapy in the era of biologics
2021, Journal of the American Academy of DermatologyCitation Excerpt :The concomitant administration of acitretin with NB-UVB has been found to hasten clinical response, reduce the required acitretin dose, and decrease the number of phototherapy sessions by approximately 20%, thereby lowering the cumulative UV dose and theoretical risk for photocarcinogenesis.14,38,40 Similar effects have been observed with acitretin plus PUVA, and given the established skin cancer risk with this modality, the coadministration of an oral retinoid is particularly valuable.40-43 Because retinoids have a keratolytic effect, phototherapy dose escalations must be proceeded with cautiously when using this combination.14
Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies
2020, Journal of the American Academy of DermatologyAcitretin
2016, Therapy for Severe PsoriasisGuidelines for phototherapy of mycosis fungoides and Sézary syndrome: A consensus statement of the United States Cutaneous Lymphoma Consortium
2016, Journal of the American Academy of DermatologyCitation Excerpt :Retinoids decrease the thickness of the epidermis,110 enhancing UV penetration and causing a more brisk response to UV exposure. There are data to support the safe use of PUVA with etretinate67 and, by extension, other retinoids, including acitretin,111 isotretinoin,67 and bexarotene112,113 in patients with MF or psoriasis. In psoriasis, both the number of PUVA treatments and the total amount of UVA exposure to achieve CR are decreased with the addition of an oral retinoid to a regimen of PUVA.111
Phototherapy of Mycosis Fungoides
2015, Dermatologic ClinicsCytotoxic and genotoxic effects of acitretin, alone or in combination with psoralen-ultraviolet A or narrow-band ultraviolet B-therapy in psoriatic patients
2013, Mutation Research - Genetic Toxicology and Environmental Mutagenesis
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From the Department of Dermatology, The Mount Sinai School of Medicine, New York.
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This manuscript is based on a presentation given at the 5th European Congress on Psoriasis/7th International Psoriasis Symposium in Milan, Italy on September 2, 1998, with support from Roche Laboratories, Inc., Nutley, NJ.
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Reprint requests: Mark Lebwohl, MD, One Gustave L. Levy Place, New York, NY 10029.
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