alitretinoin and Psoriasis

Palmoplantar pustulosis (PPP) is an inflammatory, debilitating skin disease. Topical drugs and systemic immunosuppressive agents are often ineffective. Previous uncontrolled studies have suggested that alitretinoin could be a meaningful treatment option for PPP.. The primary objective was to determine response to alitretinoin for the treatment of PPP based on the Palmoplantar Pustulosis Area and Severity Index (PPPASI) after 24 weeks of treatment.. A phase II, randomized, double-blind, placebo-controlled, multicentre study. Adult patients with PPP (with or without psoriasis) refractory to topical therapy and standard skin care were randomized 2:1 to alitretinoin 30 mg once daily or placebo for up to 24 weeks. The primary end point was PPPASI at week 24 (or the last visit in case of early withdrawal). Secondary end points included: percentage change from baseline in the modified Psoriasis Area and Severity Index (mPASI); percentage of patients with ≥ 50% or 75% improvement in PPPASI or mPASI scores from baseline; change in pustule count on the palms and soles; change in the Nail Psoriasis Severity Index and safety and tolerability assessments.. Thirty-three patients were randomized: 24 patients to alitretinoin 30 mg and nine to placebo. Overall, there were no significant differences between alitretinoin 30 mg and placebo for any end point. The safety profile was consistent with that seen in patients with chronic severe hand eczema refractory to potent topical corticosteroids.. Although the results were unexpected based on previous studies of alitretinoin in the treatment of PPP, this study provided no evidence to support further exploration of alitretinoin in the treatment of severe PPP.

Topics: Administration, Cutaneous; Administration, Oral; Alitretinoin; Dermatologic Agents; Double-Blind Method; Drug Administration Schedule; Female; Foot Dermatoses; Hand Dermatoses; Humans; Male; Middle Aged; Psoriasis; Severity of Illness Index; Treatment Outcome; Tretinoin

Topics: Aged; Alitretinoin; Alopecia; Dermatologic Agents; Diagnosis, Differential; Hand Dermatoses; Humans; Male; Psoriasis

Topics: Alitretinoin; Exanthema; Humans; Psoriasis; Skin Diseases, Vesiculobullous; Tretinoin

Chronic itch with secondary scratch lesions such as prurigo has a major impact on quality of life. Due to its relapsing nature and often unknown origin, its treatment is challenging.. We sought to demonstrate that alitretinoin can be an efficacious and well-tolerated treatment in a patient suffering from chronic itch with concomitant prurigo and psoriatic lesions.. Case report.. After 1 month of alitretinoin treatment (30 mg daily), itch as well as prurigo and psoriasis lesions decreased markedly. Three cycles of alitretinoin were administered, as each cessation of treatment led to relapse of the symptoms after 6-8 weeks. Tapering of the alitretinoin dose (30 mg every second day) after the third cycle allowed to maintain the effects for over 18 months.. Treatment of refractory prurigo with alitretinoin might be an efficacious alternative to standard therapies. In case of relapse, retreatment with alitretinoin reinduces a further long-lasting response.

Topics: Alitretinoin; Antineoplastic Agents; Female; Humans; Middle Aged; Prurigo; Pruritus; Psoriasis; Retreatment; Tretinoin

Topics: Acitretin; Adolescent; Alitretinoin; Antibodies, Monoclonal; Dermatologic Agents; Drug Therapy, Combination; Humans; Infliximab; Male; Psoriasis; Severity of Illness Index; Treatment Outcome; Tretinoin; Tumor Necrosis Factor-alpha

Palmoplantar pustular psoriasis is often recalcitrant to therapy. Here we evaluated the therapeutic effect of alitretinoin in patients with recalcitrant palmoplantar pustular psoriasis and investigated subsequent immunopathological alterations.. Seven patients with palmoplantar pustular psoriasis were treated with oral alitretinoin 30 mg once daily for 12 weeks. Efficacy was assessed by palmoplantar pustular psoriasis area and severity index (PPPASI), visual analogue scales (VAS) on intensity of pain and pruritus and an overall patient assessment. Immunohistochemical staining for neutrophil elastase, CD3, CD4, CD8, CD1a CD11c, CD303,CD68, CD69, CD208 and HLA-DR was on lesional skin biopsies obtained before and after 12 weeks of treatment.. PPPASI and VAS for pruritus and pain decreased significantly after 12 weeks of treatment with alitretinoin. The overall patient assessment ranged from 60% to 90% clinical improvement. In correlation with clinical improvement a significant reduction, particularly of neutrophils, macrophages and dendritic cells, was also observed in the skin sections. Alitretinoin was well tolerated except for headache during the first month of treatment in two patients. Limitations of the study are a missing control group and the concomitant usage of topical therapy.. Our findings suggest that alitretinoin may represent a new and promising therapy for recalcitrant palmo-plantar psoriasis and warrants further controlled studies to confirm efficacy and safety of alitretinoin in this disease.

Topics: Adult; Aged; Alitretinoin; Antineoplastic Agents; Female; Humans; Inflammation; Male; Middle Aged; Psoriasis; Treatment Outcome; Tretinoin; Young Adult