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Single‐center retrospective study of long‐term use of low‐dose acitretin (Soriatane®) for psoriasis

BACKGROUND: Indicated as monotherapy for severe psoriasis in adults, acitretin (Soriatane®) can be used in combination therapy or as a ‘disease‐stabilizing, maintenance’ agent. While its efficacy for psoriasis and other disorders of keratinization is well established, its safety is often a concern for many dermatologists. The possible side effects associated with short‐term treatment of oral retinoids include mucocutaneous effects, elevation in serum lipid chemistries and liver enzymes, and teratogenicity. However, the only possible long‐term, cumulative side effect is skeletal and ligamentous calcification such as hyperostosis. There is a specific syndrome of hyperostosis associated with oral retinoids called DISH (diffuse idiopathic skeletal hyperostosis). OBJECTIVE: To examine the incidence of DISH syndrome in long‐term acitretin use for psoriasis and to quantify the incidence of other side effects. METHODS: All patients seen at the UCSF Psoriasis and Skin Treatment Center who had been on acitretin for more than 1 year were identified. RESUTLS: A chart review of these patients revealed no X‐ray‐confirmed cases of DISH syndrome, minimal changes in coronary heart disease risk indicators, and extremely rare significant elevation of liver enzymes. CONCLUSION: Acitretin does not appear to cause significant long‐term side effects at low doses; the implications for thousands of patients are that use of this medication can be continued for long periods of time with routine monitoring.