Acitretin-Induced Hepatitis: When to Monitor Cholestatic Enzymes

Abstract

This is the first literature review on acitretin-induced hepatitis. Although acitretin-induced hepatoxicity is rare, the seemingly unusual presentation of a mixed pattern of hepatocyte injury and cholestasis may be more common than previously thought. The findings should encourage clinicians not only to monitor transaminases but also to consider measuring cholestatic enzymes (ALP/GGT) in patients with transaminase abnormalities.

Severe and Prolonged Liver Damage in Pityriasis Rubra Pilaris Treated with acitretin: a Case Report

“…Adverse effects to the liver are the reason for regular laboratory tests especially in the beginning of therapy. Reported prevalences of transaminase elevation during acitretin treatment range from less than 1 to up to 16% [9]. Marked elevations (> 3 × ULN) are estimated to occur in 1-5% of acitretin-treated patients.…”

Risk of Psychiatric Disorders in Patients with Psoriasis Prescribed Acitretin versus Disease-Modifying Antirheumatic Drugs: A Nationwide Matched Cohort Study

“…Liver diseases are neither uncommon in psoriasis patients [40] nor absolute contraindications of acitretin treatment. Nevertheless, studies have demonstrated hepatobiliary toxicity with acitretin therapy because of hepatic mitochondrial dysfunction and sinusoidal congestion [41]. Although such liver injury is infrequent and transient, persistent elevation of liver enzymes has been reported in the setting of preexisting liver diseases [41].…”

“…Nevertheless, studies have demonstrated hepatobiliary toxicity with acitretin therapy because of hepatic mitochondrial dysfunction and sinusoidal congestion [41]. Although such liver injury is infrequent and transient, persistent elevation of liver enzymes has been reported in the setting of preexisting liver diseases [41]. In addition, the metabolism of acitretin primarily takes place in the liver, followed by drug elimination partly through the bile [42].…”