Joint American Academy of Dermatology–National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies

Abstract

Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 2% of the world's population. In this guideline, we focus the discussion on systemic, nonbiologic medications for the treatment of this disease. We provide detailed discussion of efficacy and safety for the most commonly used medications, including methotrexate, cyclosporine, and acitretin, and provide recommendations to assist prescribers in initiating and managing patients on these treatments. Additionally, we discuss newer therapies, including tofacitinib and apremilast, and briefly touch on a number of other medications, including fumaric acid esters (used outside the United States) and therapies that are no longer widely used for the treatment of psoriasis (ie, hydroxyurea, leflunomide, mycophenolate mofetil, thioguanine, and tacrolimus).

Drug survival and safety profile of acitretin monotherapy in patients with psoriasis: A multicenter retrospective study

“…9 Almost all patients experience adverse effects; the most common adverse effect of acitretin is mucocutaneous, such as dryness of the skin and mucous membranes. 3,4,10,11 Among them, the most common adverse effect, cheilitis, is especially dose-dependent, observed in between 10.9% and 75%. [12][13][14][15] In our study, all patients received acitretin treatment at a dose of 10 to 50 mg/day.…”

Plant Kingdom as Source of Vitamins

“…Although the description of skin or mucous membranes are not frequently reported in the current medical description of vitamin A deficiency, the interest of retinoids used orally or topically, including natural tretinoin (i.e., all-(E)-retinoic acid) in a variety of dermatological conditions (Chen et al 2019b) such as acne vulgaris (Kolli et al 2019), psoriasis (Menter et al 2020), and eczema (Halioua et al 2019;Kim et al 2019), tends to confirm this physiological function.…”

Acitretin Promotes the Differentiation of Myeloid-Derived Suppressor Cells in the Treatment of Psoriasis

“…The inflammatory effect induced by the interaction between keratinocytes and activated immune cells is also the main factor leading to the pathogenesis of psoriasis (4, 5). Acitretin, a synthetic retinoid belonging to the family of retinoid analogs (RA) drugs (6), has been used as the first-line treatment of psoriasis (7). It has been reported that acitretin could suppress the proliferation of keratinocytes and regulate their differentiation in the treatment of psoriasis (8), but it has little effect on Th1, Th17, and Tregs (9,10).…”