A Prospective Study of Skeletal Changes during Short-Term Acitretin Therapy

Abstract

We prospectively analyzed skeletal changes of 16 patients who were treated with acitretin for various disorders of keratinization at doses of 10–50 mg/day (overall mean 0.4 mg/kg/day) for 7–12 months (mean 11.4 months). Skeletal changes from pretherapy findings were observed in 5 patients. In 4 of 5 patients they appeared to be linked to a preexisting degenerative pathology and could not be attributed to acitretin therapy. However, in 1 patient a spinal osseous side effect could not be excluded. No retinoid-induced extraspinal tendon or ligament calcifications were observed.

Efficacy and safety of oral retinoids in different psoriasis subtypes: a systematic literature review

“…We detected and screened 105 references among which 15 were finally included for systematic review 50–64 . A detailed flowchart described the selection process and the reasons for exclusion papers (Fig.…”

“…27,34,36,[41][42][43] Finally, there is no robust evidence for an increased risk of skeletal abnormalities with retinoid used for the treatment of psoriasis. [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64] Conclusion Acitretin may be considered as the treatment of choice for both generalized and localized pustular psoriasis even though only few studies involving a small number of patients support this recommendation. It is also a treatment option for moderate-to-severe plaque psoriasis primarily through combination regimens with UV light.…”

“…Four articles published between 1986 and 1993 provided an assessment of the incidence rate of skeletal abnormalities after 12 months retinoid treatment. 51,[53][54][55] However, the type of skeletal abnormalities was not detailed. The number of patients ranged from eight to 240.…”

Oral retinoid therapy for disorders of keratinization: single-centre retrospective 25 years' experience on 23 patients

“…Skeletal abnormalities that have been associated with retinoid therapy are periosteal thickening, premature epiphyseal closure in children, osteophytes, bony bridges between vertebrae with normal disc space, osteoporosis, extraspinal tendon and ligament calcification, and DISH characterized by anterior spinal ligament calcification 19–21 . However, there are few prospective studies on skeletal effects of long‐term systemic retinoids, and authors have commented on the difficulty in interpretation of results as most of the bony changes are also prevalent in the general population 22–25 . In the 5‐year prospective follow‐up study of psoriasis patients by Stern et al.…”

Evidence‐based recommendations on conventional systemic treatments in psoriasis: systematic review and expert opinion of a panel of dermatologists

“…The question of bone toxicity of retinoids has received much attention in the past, although the scientific evidence has not been critically appraised. Observational studies have provided an estimate of the incidence of worsening of skeletal abnormalities in patients under retinoid therapy at 1 year, 49–52 2 years 53 and 5 years 54 . The literature showed wide fluctuation in the incidence of skeletal abnormalities with no difference in exposure to retinoids in patients with or without osteo‐articular lesions.…”