The frequent use of oral retinoids in combination with other treatments for psoriasis: a retrospective analysis.
BACKGROUND
Combination treatment in psoriasis may be common, logical, and appropriate, even if not well tested or well documented by clinical trials. While oral retinoids such as acitretin can be used as monotherapy, efficacy can be further augmented by combination use with other agents. Similarly, because of its safety profile, acitretin can be added in low doses to help patients who have not achieved adequate control with other psoriasis treatments.


OBJECTIVE
The purpose of this study was to assess how oral retinoids are used in combination with other drugs to treat psoriasis.


METHODS
We assessed the use of acitretin and other oral retinoids for the treatment of psoriasis using two sources of information: nationally representative survey data from the National Ambulatory Medical Care Survey (NAMCS) and local data obtained by chart review of 518 patients seen in a university dermatology clinic.


RESULTS
In the NAMCS, oral retinoids were prescribed with other psoriasis medications at 71% of visits. In the chart review, combination use was even more frequent (96% of subjects were on combination treatment) and included combinations of acitretin with topicals, phototherapy, and other systemic treatments. Adverse events were reported in 53% of patients treated with acitretin, although none were severe.


CONCLUSIONS
Use of acitretin in combination with many other psoriasis treatments is a common practice. Mucocutaneous side effects of oral retinoids are common but with appropriate dosing are generally mild.
Department of Dermatology, Wake Forest University Health Sciences, Winston-Salem, North Carolina 27157 1071, USA.
Judy
J
Hu
Rajesh
R
Balkrishnan
Fabian
F
Camacho
Wei
W
Lang
Daniel J
DJ
Pearce
Alan B
AB
Fleischer
Steven R
SR
Feldman
D017255:Acitretin / Q000008:administration & dosage*; D000284:Administration, Oral; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy*; D012176:Retinoids / Q000008:administration & dosage*; D012189:Retrospective Studies
D003879:Dermatologic Agents; D012176:Retinoids; D017255:Acitretin