Case Report: Psoriatic Erythroderma with Bilateral Osseous Bridge Across the Acetabulum

Abstract

Abnormal reactions accompanied by bone formation in the osteoarticular region induced by long-term administration of etretinate have been reported. We treated a patient who received continuous treatment of psoriatic erythroderma with etretinate for 7 years, and who had an osseous bridge that extended across the acetabulum over the femur on both sides. The patient experienced a major gait disturbance and eventually was unable to walk. Functional gait was restored by resecting the ossified regions and radiotherapy. Histologic sections of the ossified lesions showed enchondral ossification in the ligament attachment site in the joint margin, with advancing ossification along the articular capsule; the pattern was similar to that in diffuse idiopathic skeletal hyperostosis. This is the first report of an osseous bridge associated with long-term administration of etretinate extending across the acetabulum over the femur on both sides.

Hyperostosis around the bilateral acetabulum associated with hypoparathyroidism

“…One case report described the resection of a bilateral osseous bridge across the acetabulum due to etretinate [8]. One year after surgery, plain radiographic examination showed no evidence of recurrence of our patient's ossified lesions, and she has maintained a good range of motion in her hip.…”

Dietary habits in Japanese patients with psoriasis and psoriatic arthritis: Low intake of meat in psoriasis and high intake of vitamin A in psoriatic arthritis

“…It is reported that a short‐term treatment with retinoids, synthetic derivatives of vitamin A, improved PSA . In contrast, it is reported that long‐term retinoid treatment (24–36 months with etretinate and 10 months with isotretinoin) for patients with psoriasis, PSA or other dermatoses, induces enthesopathy with hyperossification in the spine, ankles, pelvis or knees, reminiscent of diffuse idiopathic skeletal hyperostosis (DISH) . PSA belongs to spondyloarthritis showing juxtaarticular osteophytosis and is characterized by enthesitis .…”

Nutrition and Psoriasis

“…Treatment with retinoids might be associated with potential adverse effects, hyperostosis or tissue calcification [ 63 ]. It is reported that long-term treatment with retinoids, such as etretinate for 5 or 7 years [ 67 , 68 ], isotretinoin 4–6 years [ 69 ] resulted in enthesopathy with hyperossification in spines, ankles, pelvis, or knees, reminiscent of diffuse idiopathic skeletal hyperostosis (DISH) [ 67 , 70 ]. In DISH, certain factors including retinoids might stimulate mesenchymal stem cells at the periosteum or ligaments, and promote their abnormal osteoblast differentiation, leading to the hyperostosis at entheses [ 70 ].…”