A case of Reiter's disease with severe skin manifestations successfully treated with oral etretinate

A case of Reiter's syndrome with severe keratoderma being successfully treated with oral Etretinate is reported. A 38 year-old man was referred to our hospital in December, 1985 for treatment of refractory skin eruptions and polyarthralgia. He previously experienced urethritis in December, 1983 with subsequent development of high fever, balanitis, skin eruptions and polyarthritis. Treatments with antibiotics, anti-inflammatory drugs and glucocorticoids were ineffective at that time. The patient was diagnosed as Reiter's syndrome based on his clinical symptoms and the presence of HLA-B27. He was treated in our clinic with oral administration of Etretinate, aromatic retinoids, at the initial doses of 40 mg/day with subsequent increase up to 75 mg/day in 2 weeks. This maintenance dose was continued for two months, resulted in improvements of joint pain, skin eruptions and the laboratory abnormalities. The doses of Etretinate was gradually decreased and then was discontinued after 4 months, when approximately 90% of the skin lesion disappeared. No noticeable side-effect was observed except slight stomatitis. The remission continued for about 2 and half years after cessation of Etretinate without any medication. However, evidence of relapse with the same skin lesions and arthralgia was observed in March, 1989. A repeated treatment with oral Etretinate was attempted with similar but slightly delayed effects.