Effects of acitretin on the liver.
BACKGROUND
Therapy with aromatic retinoids for psoriasis is associated with abnormal liver function test findings and toxic hepatitis (in 1.5% of patients).


OBJECTIVE
Our purpose was to determine the safety of acitretin with respect to liver function, on the basis of biopsy.


METHODS
We treated 128 adults (with chronic, stable psoriasis) with oral acitretin (25-75 mg/day) for four 6-month intervals in a prospective, open-label, 2-year multicenter study. Liver biopsies were performed before and after study completion (2 years).


RESULTS
Eighty-three available pairs of pretreatment and posttreatment liver biopsies demonstrated no change in 49 patients (59%), improvement in 20 (24%), and worsening in 14 (17%). Of these 14 patients with decrements in biopsy status, most changes were mild. There was no correlation between liver function test abnormalities or cumulative acitretin dose and changes in liver biopsy status.


CONCLUSIONS
Acitretin therapy elicited no biopsy-proven hepatotoxicity in this prospective 2-year study. These findings suggest that periodic liver biopsy may not be necessary with acitretin treatment.
Roenigk
H H
HH
Arizona Advanced Dermatology, Phoenix, Arizona, USA.
Callen
J P
JP
Guzzo
C A
CA
Katz
H I
HI
Lowe
N
N
Madison
K
K
Nigra
T
T
Fiedler
V C
VC
Armstrong
R B
RB
D017255:Acitretin / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D001706:Biopsy; D005260:Female; D006801:Humans; D007641:Keratolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects* / Q000201:enzymology / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D011565:Psoriasis / Q000188:drug therapy
D007641:Keratolytic Agents; D017255:Acitretin