tretinoin and Hyperlipoproteinemias

Etretinate and isotretinoin were compared with respect to their clinical effects and changes in serum lipoprotein concentrations. Sixteen patients with hyperkeratotic and pustular disorders of hands and feet (mainly palmoplantar pustulosis) underwent a double-blind cross-over study. The daily doses of etretinate and isotretinoin were 50 and 40 mg, respectively. Each drug was given for 2 months with a 2-month intermission. The clinical score was reduced both by isotretinoin (P less than 0.05) and etretinate (P less than 0.001). Both drugs affected the lipoprotein concentrations. Isotretinoin increased the cholesterol concentration in low-density lipoprotein (LDL) by 20% and the triglyceride concentration in very low-density lipoprotein (VLDL) by 35%, but decreased the high-density lipoprotein cholesterol by 12%. Etretinate elevated LDL-cholesterol by 10%. These changes had reverted to normal 8 weeks after the end of treatment. The data suggest that in the diseases studied, etretinate is preferable to isotretinoin with regard to both clinical effect and serum lipid side-effects.

Topics: Adult; Aged; Clinical Trials as Topic; Double-Blind Method; Etretinate; Female; Humans; Hyperlipoproteinemias; Isotretinoin; Lipoproteins; Male; Middle Aged; Skin Diseases; Tretinoin

Although retinoid derivatives are an effective treatment for severe psoriasis, they result in systemic toxicity, including hyperlipidemia. In an attempt to reverse this retinoid-related hyperlipidemia in patients with psoriasis, a prospective 4-week pilot study of fish oil supplementation was carried out in 25 patients with psoriasis vulgaris receiving etretinate (Ro-10-9359) or acitretin (Ro 10-1670). Daily fish oil supplements containing 3 gm of omega-3 fatty acids (1.8 gm of eicosapentaenoic acid 20:5 omega 3, and 1.2 gm of docosahexaenoic acid 22:6 omega 3) were found to be effective in reducing hypertriglyceridemia, with a significant mean reduction from 215.6 +/- 92.5 to 156.9 +/- 58.5 mg/dl (-27%) when compared with controls (203.6 +/- 46.9 to 204.1 +/- 54.3 mg/dl). High-density lipoprotein cholesterol levels increased from 41.4 +/- 10.5 to 46.1 +/- 10.8 mg/dl (+11%), and the ratio of total cholesterol to high-density lipoprotein cholesterol decreased from 6.6 +/- 1.9 to 5.9 +/- 1.7 (-11%). It is concluded that fish oil supplementation may prove a valuable adjunct to ameliorate the lipid changes secondary to retinoids.

Topics: Acitretin; Adult; Aged; Cholesterol; Cholesterol, HDL; Etretinate; Female; Fish Oils; Humans; Hyperlipoproteinemias; Male; Middle Aged; Prothrombin Time; Psoriasis; Tretinoin; Triglycerides

Since systemic administration of synthetic retinoids was introduced into dermatology and oncology, side-effects of synthetic vitamin-A derivatives on lipid and lipoprotein metabolism have become apparent. Retinoids of the first and second generation, 13-cis-retinoic acid and etretinate, are capable of inducing secondary hyperlipoproteinemias. For further evaluation of the atherogenic risk of retinoid-induced hyperlipoproteinemias, the most relevant effects of natural and synthetic retinoids on lipid metabolism as well as the interactions between lipid and retinoid metabolism are considered in this review.

Topics: Arteriosclerosis; Biotransformation; Cholesterol; Chylomicrons; Etretinate; Humans; Hyperlipoproteinemias; Lipids; Lipoproteins; Retinoids; Retinol-Binding Proteins; Tretinoin; Triglycerides; Vitamin A

Topics: Animals; Disease Models, Animal; Hyperlipoproteinemias; Lipoproteins, VLDL; Liver; Male; Rats; Tretinoin; Triglycerides