ABSTRACT
The systemic retinoids have been used for a multitude of purposes including the treatment of psoriasis, nodulocystic or recalcitrant acne, and cutaneous T-cell lymphoma. This chapter focuses on general recommendations for the treatment of psoriasis in combination with other systemic agents, for use in children, and in special populations for example, immunocompromised and hepatitis B or C positive patients. Acitretin is a second-generation systemic retinoid that binds poorly but activates all three retinoic acid receptors subtypes which are alpha, beta, and gamma. Acitretin can be used to enhance the effects of broadband ultraviolet B (BB-UVB) phototherapy, resulting in lower cumulative doses of BB-UVB and fewer treatments. Acitretin may be used in combination with other systemic agents to enhance their effects. Sequential therapy with cyclosporine and acitretin is one such regimen. Acitretin is teratogenic and carries a category X pregnancy rating. Exposure during the first three to six weeks of gestation causes toxic effects on neural crest development.
