title: Acitretin for the treatment of psoriasis: an assessment of national trends.
abstract: BACKGROUND
  Combination therapy is a common and appropriate treatment strategy for moderate-to-severe psoriasis, as it provides for enhanced efficacy and decreased toxicity compared to the use of a single agent. Acitretin is an effective oral retinoid for psoriasis that seems to find its greatest value when complemented by other topical and systemic treatments.
  
  
  OBJECTIVE
  The primary aim of this study is to assess the use of acitretin in combination with other treatments for psoriasis.
  
  
  METHODS
  We assessed the use of acitretin for the treatment of psoriasis using nationally representative survey data from the National Ambulatory Medical Care Survey (NAMCS).
  
  
  RESULTS
  Among visits where acitretin was listed in the NAMCS, other psoriasis medications were co-prescribed in 62 percent of visits. The co-prescribed medications included topical corticosteroids (51%), calcipotriene (31%), biologics (6%), cyclosporine (5%), methotrexate (5%) and tazarotene (2%).
  
  
  CONCLUSIONS
  The use of acitretin in combination with other psoriasis treatments, particularly topical corticosteroids and calcipotriene, is a common practice. Acitretin is co-prescribed with the biologics, likely because of the relative lack of overlapping effects on immune function. The immune-sparing method of action of acitretin makes combination treatment with the systemic agents an attractive treatment option, especially in patients where further immunosuppression is unwarranted.
authors.affiliation: Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Pedram
authors.initials: P
authors.lastname: Ghasri
authors.forename: Brad A
authors.initials: BA
authors.lastname: Yentzer
authors.forename: Tushar S
authors.initials: TS
authors.lastname: Dabade
authors.forename: Steven R
authors.initials: SR
authors.lastname: Feldman
mesh_terms: D017255:Acitretin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000287:Administration, Topical; D003131:Combined Modality Therapy; D016208:Databases, Factual; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006801:Humans; D007641:Keratolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D012176:Retinoids / Q000008:administration & dosage / Q000627:therapeutic use; D014481:United States
chemical_list: D003879:Dermatologic Agents; D007641:Keratolytic Agents; D012176:Retinoids; D017255:Acitretin