Efficacy of acitretin in the treatment of reactive neutrophilic dermatoses in adult‐onset immunodeficiency due to interferon‐gamma autoantibody

Abstract

Reactive neutrophilic dermatoses in adult-onset immunodeficiency due to interferon-c autoantibody (AOID) are usually associated with concomitant active opportunistic infections. Data focusing on the treatment of these dermatoses with non-immunosuppressive drugs are still lacking. The aim of this study was to assess the efficacy and safety of acitretin treatment of reactive neutrophilic dermatoses in AOID. We conducted a retrospective review of all patients with AOID who had reactive neutrophilic dermatoses and had been treated with acitretin from January 2008 to December 2018. In total, 23 patients had been diagnosed with AOID, with 27 episodes of reactive neutrophilic dermatoses (20 episodes of Sweet syndrome and seven episodes of generalized pustular eruption) and treated with acitretin. The median effective dose of acitretin was 10 mg/day. The mean initial response was 5.6 AE 2.3 days. The rash had almost or completely cleared within 2 weeks in 70.4% of patients. One case had developed a reversible acitretin-induced liver injury with hepatocellular pattern. The median total duration of treatment was 3 months. In conclusion, this study demonstrates the potential role of acitretin as one of the treatments of choice for reactive neutrophilic dermatoses in AOID, attributable to its favorable response and good tolerability.

New Practical Aspects of Sweet Syndrome

“…Additionally, the successful management of SS with acitretin [159] further supports this conjecture, as acitretin has been shown to inhibit neutrophil migration [167]. A similar hypothesis posits that in cases of hematologic malignancy, dysplastic neutrophils (of the same clonal origin as malignant myeloblasts) have an inherently greater capacity to localize to the dermis and incite inflammation [166].…”

“…More recent studies have described additional therapeutic options for SS. In a 20-patient retrospective study, acitretin at a dosage of 10-50 mg/day contributed to complete/near complete remission of SS in all patients; moreover, 14 patients experienced remission within 2 weeks of initiating treatment [159]. Dapsone is also supported by a modicum of evidence.…”

Neuro-Sweet Syndrome: A Diagnostic Conundrum

“…5 A recent study using the latter showed a 70% remission rate in 2 weeks although these patients did not have neurologic involvement. 10 It is believed that this response is based on its ability to prevent neutrophil migration making it an appealing choice for avoiding immunosuppressants. 11 There have also been reports of remission of the disease by treating the underlying neoplastic disorder or discontinuing the offending drug.…”

Bullous Sweet syndrome in a patient with acute myeloid leukemia treated with midostaurin: Rapid response to acitretin and colchicine—A case report

“…Treatment with colchicine and acitretin which has an inhibitory effect on neutrophil migration from the blood to tissues have also been reported. [7][8][9] Acitretin in combination with colchicine may provide a safe and effective alternative regimen. However, this is only a single case report of successful treatment with acitretin as adjunctive therapy to colchicine, further study is warranted to support this hypothesis.…”