Prednisone, Acitretin

1. Acitretin: General
   • Vitamin A derivative
   • Better in keratinizing disorders than acne
   • High bioavailability, but absorption enhanced by fatty meal
   • Alcohol converts it into etretinate, with much longer half life; Alcohol avoidance!
2. Acitretin: Use
   • Approved for plaque psoriasis
   • Used for PsO variants, and many other disorders (off label)
   • Chemoprevention (off-label)
3. Acitretin: AEs (most common)
   • Teratogen: adequate contraception one month before and three years after taking
   • “Sticky skin” and cheilitis and onycholysis
   • Hyperlipidemia
4. Acitretin dose
   • Supplied as 10, 17.5, 25 mg color-coded capsules
   • 25-50mg daily initial and maintenance, titrated to response
5. Prednisone: one of many “steroids” with similar basic structure
6. Prednisone: General
   • Dose alterations due to change in binding globulin: thyroid dysfunction, obesity, pregnancy, OCP ingestion, hepatic dysfunction
   • Immunosuppressive and anti-inflammatory
7. Prednisone: Use
   • Bullous diseases
   • Connective tissue diseases
   • Reactive states (EM, SJS)
   • Dermatitis, including neutrophilic dermatoses and Vasculitis
   • Miscellaneous diseases (eg. Sarcoid)
8. Prednisone AEs (most common)
   • Increased appetite, weight, fluid retention, edema
   • Menstrual irregularities (40%)
   • Gastritis, Glaucoma
   • Agitation and insomnia
   • Loss of bone density
   • Steroid acne
   • (Risk of worsening infections, Pseudotumor cerebri)
   • Relative safety in pregnancy (Class C): risk of cleft lip/palate