Skip to main content

Advertisement

SpringerLink
Log in

Management of Psoriasis

The Position of Retinoid Drugs

  • Disease Management
  • Published:
BioDrugs Aims and scope Submit manuscript

Abstract

Oral synthetic retinoids have been established as effective systemic therapy for psoriasis since their introduction for clinical use in the 1970s; a compound for topical use, tazarotene has been recently marketed. Despite the demonstrated clinical success of retinoid therapy in psoriasis, its mechanism of action has not been fully elucidated, and investigators are confronted with two paradoxes. One is that the binding of retinoids to nuclear retinoic acid receptors (RARs) does not match their therapeutic efficacy: acitretin activates the three receptor subtypes, RAR-α, -β and -γ, without measurable receptor binding, whereas tazarotene preferentially binds to and activates RAR-β and -γ in preference to RAR-α. The other is that there is already increased formation of retinoic acid in the psoriatic lesion. Answering these questions should result in better use of these drugs in the treatment of psoriasis.

Oral administration of acitretin remains one of the first therapeutic choices for severe psoriasis, particularly in association with ultraviolet light therapy, of which it may decrease the carcinogenic risk. Topical tazarotene is suitable for moderate plaque psoriasis. Its efficacy and tolerability can be enhanced by the addition of topical corticosteroids; its irritative potential is counterbalanced by a sustained therapeutic effect after the treatment is stopped.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Saurat JH. Retinolds and psoriasis: novel issues in retinoid pharmacology and implications for psoriasis treatment. J Am Acad Dermatol 1999; 41: 2–6

    Article  Google Scholar 

  2. Nickoloff BJ, Wrone-Smith T, Bonish B, et al. Response of murine and normal human skin to injection of allogenic blood-derived psoriatic immunocytes: detection of T cells expressing receptors typically present on natural killer cells, including CD94, CD158, and CD161. Arch Dermatol 1999; 135: 546–52

    Article  PubMed  CAS  Google Scholar 

  3. Siegenthaler G, Gumowski-Sunek D, Saurat JH. Metabolism of natural retinoids in psoriatic epidermis. J Invest Dermatol 1990; 95: S47–8

    Article  Google Scholar 

  4. Geiger JM, Saurat SH. Acitretin and etretinate. How and when should they be used. Dermatol Clin 1993; 11: 117–29

    PubMed  CAS  Google Scholar 

  5. Saurat JH. Systemic retinoids. What’s new? Dermatol Clin 1998; 16: 331–40

    Article  PubMed  CAS  Google Scholar 

  6. Chandraratna RA. Tazarotene —first of a new generation of receptor-selective retinoids. Br J Dermatol 1996; 135: 18–25

    Article  PubMed  CAS  Google Scholar 

  7. Bollag W. New retinoids with potential use in humans. In: Saurat JH, editor. Retinoids: new trends in research and therapy. Basel: Karger, 1985: 274-88

    Google Scholar 

  8. Geiger JM, Czarnetzki B. Acitretin (Ro 10-1670, etretin): overall evaluation of clinical studies. Dermatologica 1988; 176: 182–90

    Article  PubMed  CAS  Google Scholar 

  9. Brindley C. An overview of recent clinical pharmacokinetic studies with acitretin (Ro 101670, etretin). Dermatologica 1989; 178: 79–87

    Article  PubMed  CAS  Google Scholar 

  10. Colburn WA, Gibson DM, Rodriguez LC, et al. Effect of meals on the kinetics of etretinate. J Clin Pharmacol 1985; 25: 583–9

    PubMed  CAS  Google Scholar 

  11. Wiegand UW, Chou RC. Pharmacokinetics of acitretin and etretinate. J Am Acad Dermatol 1998; 39: S25–33

    Article  PubMed  CAS  Google Scholar 

  12. Wiegand UW, Jensen BK. Pharmacokinetics of acitretin in humans. In: Saurat JH, editor. Retinoids: 10 years on. Basel: Karger, 1991: 192–203

    Google Scholar 

  13. Jensen BK, Chaws CL, Huselton CA. Clinical evidence that acitretin is esterified to etretinate when administered with ethanol [abstract]. FASEB J 1992; 6: A 1570

    Google Scholar 

  14. Lassus A, Geiger JM. Acitretin and etretinate in the treatment of palmoplantar pustulosis: a double-blind comparative trial. Br J Dermatol 1988; 119: 755–9

    Article  PubMed  CAS  Google Scholar 

  15. Ledo A, Martin M, Geiger JM, et al. Acitretin (Ro 10-1670) in the treatment of severe psoriasis: a randomized double-blind parallel study comparing acitretin and etretinate. Int J Dermatol 1988; 27: 656–60

    Article  PubMed  CAS  Google Scholar 

  16. Kragballe K, Jansen CT, Geiger JM, et al. A double-blind comparison of acitretin and etretinate in the treatment of severe psoriasis: results of a Nordic multicenter study. Acta Derm Venereol 1989; 69: 35–40

    PubMed  CAS  Google Scholar 

  17. Gollnick H, Bauer R, Brindley C, et al. Acitretin versus etretinate in psoriasis: clinical and pharmacokinetic results of a German multicenter study. J Am Acad Dermatol 1988; 19: 458–69

    Article  PubMed  CAS  Google Scholar 

  18. Bjerke JR, Geiger JM. Acitretin versus etretinate in severe psoriasis: a double-blind randomized Nordic multicenter study in 168 patients. Acta Derm Venereol 1989; 146 (1 Suppl. ): 206–7

    CAS  Google Scholar 

  19. Saurat JH, Geiger JM, Amblard P, et al. Randomized double-blind multicenter study comparing acitretin-PUVA, etretinate-PUVA, and placebo-PUVA in the treatment of severe psoriasis. Dermatologica 1988; 177: 218–24

    Article  PubMed  CAS  Google Scholar 

  20. White SI, Marks JM, Shuster S. Etretinate in pustular psoriasis of palms and soles. Br J Dermatol 1985; 113: 581–5

    Article  PubMed  CAS  Google Scholar 

  21. Wolska H, Jablonska S, Bounameaux Y. Etretinate in severe psoriasis. J Am Acad Dermatol 1983; 9: 883–9

    Article  PubMed  CAS  Google Scholar 

  22. Wolska H, Jablonska S, Langner A, et al. Etretinate therapy in generalized pustular psoriasis (Zumbusch type). Dermatologica 1985; 171: 297–304

    Article  PubMed  CAS  Google Scholar 

  23. Dubertret L, Chastang C, Beylot C, et al. Maintenance treatment of psoriasis by Tigason: a double-blind randomized clinical trial. Br J Dermatol 1985; 113: 323–30

    Article  PubMed  CAS  Google Scholar 

  24. Elimann CW, Vorhees JJ. International studies of the efficacy of etretinate in the treatment of psoriasis. J Am Acad Dermatol 1982; 6: 692–6

    Article  Google Scholar 

  25. Ellis CN, Vorhees JJ. Etretinate therapy. J Am Acad Dermatol 1987; 16: 267–91

    Article  PubMed  CAS  Google Scholar 

  26. Kingston T, Matt L, Lowe N. Etretin therapy for severe psoriasis. Arch Dermatol 1987; 123: 55–8

    Article  PubMed  CAS  Google Scholar 

  27. Lowe NI. When systemic retinoids fail to work in psoriasis. In: Saurat JH, editor. Retinoids: 10 years on. Basel: Karger, 1991: 341–9

    Google Scholar 

  28. Viglioglia PA, Villanueva CR, Martorano AD, et al. Efficacy of acitretin in severe cutaneous lichen planus. J Am Acad Dermatol 1990; 22: 852–3

    Article  PubMed  CAS  Google Scholar 

  29. Dubertret L. Etretinate (Tigason, Europe; Tegison, USA) in psoriasis: advantages of low doses progressively increased. J Am Acad Dermatol 1985; 13: 830–1

    Article  PubMed  CAS  Google Scholar 

  30. Berbis P, Geiger JM, Vaisse C, et al. Benefit of progressively increasing doses during the initial treatment with acitretin in psoriasis. Dermatologica 1989; 178: 88–92

    Article  PubMed  CAS  Google Scholar 

  31. Lassus A, Geiger JM, Nyblom M, et al. Treatment of severe psoriasis with etretin (Ro 101670). Br J Dermatol 1987; 177: 333–41

    Article  Google Scholar 

  32. Goldfarb M, Ellis C, Gupta A, et al. Acitretin improves psoriasis in a dose-dependent fashion. J Am Acad Dermatol 1988; 18: 655–62

    Article  PubMed  CAS  Google Scholar 

  33. Van der Rhee W. Combined treatment of psoriasis with a new aromatic retinoid (Tigason) in low dosage orally and triamcinolone acetonide cream topically: a double blind trial. Br J Dermatol 1980; 102: 203–12

    Article  PubMed  Google Scholar 

  34. Orfanos CE, Runne U. Systemic use of a new retinoid with and without local dithranol treatment in generalized psoriasis. Br J Dermatol 1976; 95: 101–3

    Article  PubMed  CAS  Google Scholar 

  35. Grupper C, Berretti B. Treatment of psoriasis by oral PUVA therapy combined with aromatic retinoid (Ro 10-9359; Tigason). Dermatologica 1981; 162: 404–13

    Article  PubMed  CAS  Google Scholar 

  36. Lauharanta J, Juvkoski R, Lassus A. A clinical evaluation of the effects of an aromatic retinoid (Tigason), combination of retinoid and PUVA, and PUVA alone in severe psoriasis. Br J Dermatol 1981; 104: 325–32

    Article  PubMed  CAS  Google Scholar 

  37. Heidbreder G, Christophers E. Therapy of psoriasis with retinoid plus PUVA: clinical and histologic data. Arch Dermatol 1979; 264: 331–7

    Article  CAS  Google Scholar 

  38. Fritsch PO, Hoenigsmann H, Jaschke H, et al. Augmentation of oral methoxsalen-photochemotherapy with an oral retinoic acid derivative. J Invest Dermatol 1978; 70: 17882

    Article  Google Scholar 

  39. Tanew A, Guggenbichler A, Hoenigsmann H, et al. Photochemotherapy for severe psoriasis without or in combination with acitretin: a randomized, double-blind comparison study. J Am Acad Dermatol 199 1; 25: 682–4

  40. Lindelof B, Sigurgeirsson B, Tegner E, et al. PUVA and cancer: a large-scale epidemiological study. Lancet 1991; II: 91–3

    Article  Google Scholar 

  41. Lauharanta J, Geiger JM. A double-blind comparison of acitretin and etretinate in combination with bath PUVA in the treatment of extensive psoriasis. Br J Dermatol 1989; 121: 107–12

    Article  PubMed  CAS  Google Scholar 

  42. Orfanos CE, Steigleder GK, Pullman H, et al. Oral retinoid and UVB radiation: a new alternative treatment for psoriasis on an out-patient basis. Acta Derm Venereol 1979; 59: 241–4

    PubMed  CAS  Google Scholar 

  43. Lowe N-L, Prystowsky J, Bourget T, et al. Acitretin plus UVB therapy for psoriasis. J Am Acad Dermatol 1991; 24: 591–4

    Article  PubMed  CAS  Google Scholar 

  44. Ruzicka T, Sommerburg C, Braun-Falco O, et al. Efficiency of acitretin in combination with UVB in the treatment of severe psoriasis. Arch Dermatol 1990; 126: 482–6

    Article  PubMed  CAS  Google Scholar 

  45. Buccheri L, Katchen BR, Karter AJ, et al. Acitretin therapy is effective for psoriasis associated with human immunodeficiency virus infection. Arch Dermatol 1997; 133: 711–5

    Article  PubMed  CAS  Google Scholar 

  46. Kistler A, Humniler H. Teratogenesis and reproductive safety evaluation of the retinoid etretin (Ro 10-1670). Arch Toxicol 1985; 58: 50–6

    Article  PubMed  CAS  Google Scholar 

  47. Halioua B, Saurat JH. Risk: benefit ratio in the treatment of psoriasis with systemic retinoids. Br J Dermatol 1990; 122 Suppl. 36: 135–50

    Article  PubMed  Google Scholar 

  48. Honigsmann H, Wolff K. Isotretinoin-PUVA for psoriasis. Lancet 1983; I: 236

    Article  Google Scholar 

  49. Anstey A, Hawk JLM. Isotretinoin-PUVA in women with psoriasis. Br J Dermatol 1997; 136: 798–9

    Article  PubMed  CAS  Google Scholar 

  50. Sofen EL, Moy RL, Lowe NJ. Treatment of generalised pustular psoriasis with isotretinoin [letter]. Lancet 1984; 7: 40

    Article  Google Scholar 

  51. Moy RL, Kingston TP, Lowe NJ. Isotretinoin vs etretinate therapy in generalized pustular and chronic psoriasis. Arch Dermatol 1985; 121: 1297–301

    Article  PubMed  CAS  Google Scholar 

  52. Wiegand UW, Cunliffe WJ, Wyss R, et al. Treatment of female patients with isotretinoin: what is the safe post-therapy contraceptive period? Presented at the Clinical Dermatology 2000 meeting, Vancouver, 1996

  53. Gollnick HPM, Finzi AF, Marks R, et al. Optimising the use of tazarotene in clinical practice: consensus statement from the European advisory panel for tazarotene (Zorac™). Dermatology 1999; 199 (1): 40–6

    Article  PubMed  CAS  Google Scholar 

  54. Lebwohl MG, Breneman DL, Goffe BS, et al. Tazarotene 0.1% gel plus corticosteroid cream in the treatment of plaque psoriasis. J Am Acad Dermatol 1998; 39: 590–6

    Article  PubMed  CAS  Google Scholar 

  55. Koo JY. Tazarotene in combination with phototherapy. J Am Acad Dermatol 1998; 39: S144–8

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, University Hospital, 24, rue Micheli-du-Crest, CH 1211, Geneva 14, Switzerland

    Ana Arechalde & Jean-Hilaire Saurai MD

Authors
  1. Ana Arechalde
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Hilaire Saurai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Hilaire Saurai MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Arechalde, A., Saurai, JH. Management of Psoriasis. BioDrugs 13, 327–333 (2000). https://doi.org/10.2165/00063030-200013050-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00063030-200013050-00003

Keywords

Search

Navigation