Advanced Systemic Therapies: Clinical Pearls from Ted Rosen, MD

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