窄谱中波紫外线照射与308nm准分子光分别联合阿维A胶囊对寻常型银屑病的疗效比较

目的比较窄谱中波紫外线照射与308 nm准分子光分别联合阿维A胶囊对寻常型银屑病的疗效。方法根据治疗方式的不同将130例寻常型银屑病患者分为A组与B组,各65例,A组予以窄谱中波紫外线照射联合维A胶囊治疗,B组予以308 nm准分子光联合维A胶囊治疗。比较两组的临床疗效、治疗前、后SCORAD、VAS、PASI、SAS、SDS评分及不良反应发生情况。结果 B组的治疗总有效率显著高于A组(P<0.05)。治疗后,两组的SCORAD、VAS和PASI评分均降低,差异具有统计学意义(P<0.05);治疗后,B组的SCORAD、VAS和PASI评分均显著低于A组,差异具有统计学意义(P<0.05)。治疗后,两组的SAS及SDS评分均降低,差异具有统计学意义(P<0.05);治疗后,B组的SAS及SDS评分略低于A组,但差异不具有统计学意义(P>0.05)。B组的不良反应总发生率显著低于A组(P<0.05)。结论 308 nm准分子光联合阿维A胶囊治疗寻常型银屑病更为安全有效,可提高患者生活质量,减少不良反应,值得推广应用。     

Clinical Efficacy and Side Effects of Acitretin on the Disorders of Keratinization: A One-year Study

Acitretin, Ro 10-1670, the principal and free acid metabolite of etretinate, was used to treat twenty patients with disorders of keratinization. An open, prospective study of clinical efficacy, tolerability, and the effects of acitretin on lipid metabolism, hepatic function, and the osteoarticular system was performed over a one year period. Each patient was initially treated with 30 mg/day of acitretin or approximately 0.6 mg/kg/day. Doses were adjusted according to the clinical efficacy and maintained for one year. There were no statistically significant changes in liver function tests or lipid profile. Twelve of eighteen evaluated patients developed asymptomatic skeletal changes; the most common change was disc space narrowing, especially at thoracic-spine level (7 of 18 patients). The earliest bone change was detected 9 months after treatment. Acitretin is effective in improving the disorders of keratinization with mild mucocutaneous side effects and asymptomatic osteoarticular changes.     

阿维A-PUVA,芳维A酸乙酯-PUVA治疗寻常型银屑病的比较

目的　比较观察阿维A PUVA ,芳维A酸乙酯 PUVA治疗寻常型银屑病的疗效。方法　 60例寻常型银屑病患者随机分为两组 ,每组 3 0例 ,分别给予口服阿维A0 .5mg·kg-1d-1加PUVA、芳维A酸乙酯 0 .5 μg·kg-1·d-1加PUVA治疗 ,观察患者PSAI分值变化。结果　芳维A酸乙酯 PUVA与阿维A PUVA疗效无显著性差异 ,芳维A酸乙酯的近期副作用轻于阿维A。结论　芳维A酸乙酯 PUVA是治疗中重度寻常型银屑病安全、有效的方案。     

阿维A治疗泛发型连续性肢端皮炎1例

报道1例泛发型连续性肢端皮炎患者，予阿维A 30mg/d治疗3周后，全身皮损基本消退，仅双手10指仍见脓疱。随后将阿维A减20mg/d，并加用PUVA治疗2周，患者痊愈。     

Hypertrophic lupus erythematosus treated successfully with acitretin as monotherapy

Hypertrophic lupus erythematosus (HLE) is a distinct and rare subset of chronic cutaneous lupus erythematosus characterized by verrucous lesions which are chronic in course and resistant to treatment (1). We describe the successful use of acitretin in a patient with HLE who had multiple hyperkeratotic verrucous plaques over the dorsa of his hands, feet, and legs and who failed to respond to local steroids and antimalarials.     

Successful use of acitretin in conjunction with narrowband ultraviolet B phototherapy in a child with severe pustular psoriasis, von Zumbusch type

Severe pustular psoriasis von Zumbusch type is a therapeutic challenge not only in adults, but even more in children. We report a 3(1/2)-year-old boy who developed a generalized flare of diffusely scattered pustules on erythematous skin which rapidly progressed to large exuding areas. The clinical presentation and investigations including histopathological examination of a biopsy and negative bacterial cultures were consistent with the diagnosis of pustular psoriasis von Zumbusch type. Upon initial treatment with methylprednisolone, acitretin and antibiotics the extent of the disease declined. However, several attempts to reduce the dose of the oral corticosteroid were followed by immediate severe flares. Additional treatment with narrowband ultraviolet B (NB-UVB, 311-313 nm UVB) resulted in a rapid arrest of disease activity and allowed the corticosteroid to be tapered off. After 10 irradiations the patient was both off steroid and disease free. NB-UVB therapy was subsequently reduced to twice-weekly exposures and acitretin gradually diminished to a maintenance dose of 0.3 mg kg(-1) daily. We conclude that NB-UVB in conjunction with acitretin is a potent therapeutic regimen for the treatment of severe pustular psoriasis von Zumbusch type in childhood.     

Alitretinoin and acitretin in severe chronic hand eczema; results from a retrospective daily practice study

Acitretin has been used off‐label for years to treat chronic hand eczema, but acitretin is less often prescribed as alitretinoïne was approved. This study evaluates both retinoids in a daily practice cohort of patients with severe chronic hand eczema in terms of drug survival and reasons for discontinuation. Patients using alitretinoin or acitretin between 01‐01‐1994 and 01‐08‐2015 were included in this retrospective daily practice study and analyzed by Kaplan‐Meier drug survival curves. Potential determinants were analyzed by Cox regression analyses. Ninety‐five patients were treated with alitretinoin and 109 patients with acitretin. The main reasons for discontinuation were adverse events and cleared hand eczema, 29.5 and 27.4% in alitretinoin versus 43.1 and 23.9% in acitretin. Patients with hyperkeratotic hand eczema had most often a good effect of treatment: 68.3% in alitretinoin and 50.7% in acitretin treatment. The drug survival rates of alitretinoin and acitretin after 12, 24, 36, and 52 weeks were 69.3, 45.1, 19.6, 7.0% and 74.3, 45.5, 33.8, 23.2%, respectively. Alitretinoin and acitretin are effective treatment options for patients with hand eczema. However, both treatments were more effective in patients with hyperkeratotic hand eczema. Fewer patients discontinued alitretinoin compared with acitretin due to adverse events.     

Multiple lichen planus‐like keratoses: Lichenoid drug eruption simulant and under‐recognised cause of pruritic eruptions in the elderly

We present six cases of multiple eruptive lichen planus‐like keratoses (LPLK), occurring in older individuals predominately confined to previously solar exposed areas. Diagnosis was often confounded by the frequent histological reporting of ‘lichenoid drug reaction’ (LDR), despite many of the patients being unmedicated. We review the literature regarding eruptive LPLK and reflect on their etiology, clinical aspects, management and importantly their clinicopathological differentiation from LDR.     

Drug fever as an adverse effect of acitretin in complicated psoriasis patient

We present a case of a 63‐year old man with severe chronic plaque psoriasis and a recent history of lung cancer, wherein fever appeared suddenly after initiation of treatment with low dose acitretin. Tumor recurrence or infection was not found during extensive examinations, nevertheless the patient was empirically treated with broad‐spectrum antibiotics without any effect on fever. Immediately after discontinuation of acitretin therapy, the fever disappeared. The patient was followed for next 2 years, during this period similar problems did not reappear, although there has been a relapse of psoriasis and the patient was switched later on biological treatment.     

Psoriasis in those planning a family,pregnant or breast‐feeding. The Australasian Psoriasis Collaboration

The Australasian Psoriasis Collaboration has reviewed the evidence for managing moderate to severe psoriasis in those who are pregnant or are breast‐feeding, or planning a family. The severity of the psoriasis, associated comorbidities and specific anti‐psoriasis treatment, along with other exposures, can have a deleterious effect on pregnancy outcomes. Psoriasis itself increases the risk of preterm and low birthweight babies, along with spontaneous and induced abortions, but no specific birth defects have been otherwise demonstrated. The baseline risk for a live born baby to have a major birth defect is 3%, and significant neuro‐developmental problem is 5%. In Australia, pregnant women with psoriasis are more likely to be overweight or obese, depressed, or smoke in their first trimester, and are also less likely to take prenatal vitamins or supplements. Preconception counselling to improve maternal, pregnancy and baby health is therefore strongly encouraged. The topical and systemic therapies commonly used in psoriasis are each discussed separately, with regards to pregnancy exposure, breast‐feeding and effects on male fertility and mutagenicity. The systemic therapies included are acitretin, adalimumab, apremilast, certolizumab, ciclosporin, etanercept, infliximab, ixekizumab, methotrexate, NBUVB, prednisone, PUVA, secukinumab and ustekinumab. The topical therapies include dithranol (anthralin), calcipotriol, coal tar, corticosteroids (weak, potent and super‐potent), moisturisers, salicylic acid, tacrolimus, and tazarotene. As a general recommendation, effective drugs that have been widely used for years are preferable to newer alternatives with less foetal safety data. It is equally important to evaluate the risks of not treating, as severe untreated disease may negatively impact both mother and the foetus.