Retinoid Therapy for Severe Dermatological Disorders

Abstract

This Policy Statement was retired January 2006. Isotretinoin is approved for the treatment of severe recalcitrant cystic acne, and etretinate is approved for the treatment of severe recalcitrant psoriasis. Women of childbearing age place their infants at risk should these compounds be used during pregnancy and, in the case of etretinate, even before pregnancy. The purpose of this statement is to describe the indications for the use of these drugs and to advise physicians of their common side effects and their teratogenic potential. Isotretinoin, 13-cis-retinoic acid (Accutane, Hoffmann-LaRoche), is a vitamin A derivative that is effective in the treatment of severe cystic acne. This type of acne, affecting adolescents and young adults, is severe, nodular, cystic, and conglobate—a scarring disease that resists treatment with topical or systemic antibiotics, benzoyl peroxide, all-trans-retinoic acid, and intralesional corticosteroids. Adolescents with less severe forms of acne who learn about the therapeutic triumphs of isotretinoin in severe recalcitrant nodular and cystic acne may assume that the drug also would be beneficial for them. Physicians should explain to these adolescents why isotretinoin is not indicated in the treatment of typical acne. Another retinoid, etretinate (Tegison, Hoffmann-La Roche), is now available for the treatment of severe psoriasis that is unresponsive to standard therapies (topical tar with UVB light, anthralin, UVA light and psoralens, systemic corticosteroids and methotrexate). Etretinate is used for severe psoriasis of both the erythrodermic and generalized pustular types. Individualization of etretinate dosage is important. Most patients are started at a dosage of 0.75 to 1.0 mg/kg of body weight per day in divided doses.