| Purpose: The purpose is to observe the efficacy of the acitretin A, which is the second-generation of etretinate,among the three different types of severe psoriasis( the vulgaris plaque-type psoriasis, the erythrodermic psoriasis and the pustular psoriasis).Method: According to clinical features we divided all the 36 patients who came to see a doctor from February 2008 to November 2014 into three groups, the first was vulgaris plaque-type psoriasis group, the second was erythrodermic psoriasis group and the third was pustular psoriasis group. Besides,the patients in the vulgaris plaque-type psoriasis group, whose Psoriasis Area and Severity Index(PASI) score ≥10 points required.Every group was treated with a different dose of acitretin. The vulgaris plaque-type psoriasis group took acitretin orally with an initial dose of 10 mg per time, twice a day,and the initial dose could be increased to 30mg/d up to most, based on its symptoms.And after the observation of improvement of the skin lesion, the dose need to be decreased and kept under a highest level of 10-20mg/d. The erythrodermic psoriasis group took acitretin 0.3-0.5/(kg·d) initially, and after 3-5 weeks, we increased the dose to 30-50 mg/d(normal dose), and if the psoriasis was controlled, the dose would be decreased to 10-20mg/d and then be kept. The pustular psoriasis group was treated with30-50mg/d initially, the dose could be set to 50mg/d up to most, based on its symptoms,and the dose would be decreased to 10-30mg/d to continue after the improvement of symptoms. The course of therapy was 8-12 weeks, and we recorded before and after the treatment in patients with PASI score, and observed the efficacy and the adverse events which occurred throughout the course of the treatment.Result: The number of the patients in the first vulgaris plaque-type psoriasis group was 11, including 5 cases achieved complete clearance, 4 cases with significant improvement, 2 cases with a less efficacy. In the second erythrodermic psoriasis group,the corresponding number was 17, 10, 3, 4; and the third pustular psoriasis group was 8,6, 2, 0. All the patients were found effective to the use of acitretin, none for invalid. The effective rate(complete clearance number + significant improvement number) of every group was lined below: the first was 81.82%, the second was 76.47%, the third was100% and the total effective rate of all patients was 83.33%.Seven indexes before and after the treatment of the 36 patients were compared.(1)number of white blood cell rate, WBC> 10 × 109/ L, 5 cases were abnormal accounting for 13.89% before treatment, while 0 case was abnormal after treatment,accounting for 0.00%;(2) number of neutrophil rate, NE> 4.8 × 109 / L, the corresponding numbers were 4, 11.11%; 0, 0.00%;(3)number of abnormal liver function, the corresponding numbers were 0, 0.00%; 4, 11.11%;(4)numbers of the increase of triglyceride were 0, 0.00%; 7, 19.44%;(5) numbers of the increase of cholesterol were 0, 0.00%; 3, 8.33%;(6) numbers of the decrease albumin were 10,27.78%; 2, 5.65%;(7) numbers of the decrease of total protein decrease were 11,30.56%; 2, 5.56%. We observed the number of these patients who suffered side effects after treating with acitretin. 7 kinds of adverse symptoms were detected as follows:(1)pruritus, 13 cases, accounting for 36.11%;(2) dry lips, 8 cases, accounting for 22.22%;(3)dry skin, 3 cases, accounting for 8.33%;(4) desquamation, 2 cases, accounting5.56%;(5) chapped lips, 1 cases, accounting for 2.78%;(6)eye dry, 1 cases, accounting for 2.78%;(7) mild headache, 1 cases, accounting for 2.78%. There were 19 cases of the all the 36 patients suffered from adverse reactions, accounting for 52.78%.Conclusion: Based on our observation, we found that acitretin was the most effective to the pustular psoriasis. Less but still effective to vulgaris plaque-type psoriasis and erythrodermic psoriasis. According to different types of psoriasis, we needed to choose different initial doses. The adverse reactions of acitretin were mainly as pruritus, skin dry, and dry mouth. These side effects would be eliminated or diminished when patients kept on taking acitretin and were given some topical treatments at the same time. Side effect varies when different dose and different course of treatment were given.So we’d best select different dose for different kind of symptom and found the correct treatment for every side effect. We’d also observe the patients’ tolerance and improvement condition and increased or decreased acitretin’s dose to achieve the best improvement. Even though the side effects had a higher occurrence rate, they were often mild and could be diminished and eliminated after we treated them correctly, so the side effects didn’t affect the usage of acitretin. Sometimes acitretin might lead to a higher rate of liver enzyme and blood lipid, but they were also mild. After correct treatment it might vanish and we didin’t need to pay more attention on it. |
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