ABSTRACT
By the 1960s, modifications of vitamin A resulted in the discovery of the first-generation retinoids, all-trans-retinoic acid and 13-cis-retinoic acid. Further research led to development of the second generation of retinoids, the monoaromatic retinoids, etretinate and its metabolite, acitretin. Etretinate and acitretin are effective treatments for psoriasis and severe congenital disorders of keratinization. Acitretin has antiproliferative and anti-inflammatory properties. Monotherapy is indicated for erythrodermic or pustular psoriasis, while combination therapy is often used for chronic plaque psoriasis. The efficacy of acitretin monotherapy in chronic plaque psoriasis is limited and dose-dependent, with approximately 70% of patients achieving a moderate or greater response. The comparative efficacy of acitretin monotherapy in chronic plaque psoriasis is less than methotrexate and ciclosporin. Acitretin is absolutely contraindicated in pregnancy, and females should not become pregnant for at least 3 years after stopping treatment. Acitretin therapy should begin on the second or third day of the menstrual cycle.
