The Efficacy And Mechanism Of Acitretin In The Treatment Of Plaque Psoriasis

Psoriasis is a chronic,recurrent,inflammatory,and systemic disease mediated by immune factors.The clinical manifestations are divided into psoriasis vulgaris,psoriasis pustulosa,psoriasis arthropathica and psoriasis erythrodermic,and the psoriasis vulgaris patients accounts for 97.06%.The etiology of psoriasis is complicated,and the pathogenesis is not fully understood.There are various treatment methods.As a metabolite of the second generation of aromatic retinoic acid etretinate,Acitretin is currently recognized as a first-line drug in the treatment of psoriasis at home and abroad.The treatment of severe psoriasis pustulosa patients and psoriasis erythrodermic patients,the effect of Acitretin is distinct.We often choose Acitretin combination therapy in the treatment of plaque psoriasis,and still fewer researches related to Acitretin single drug on the plaque psoriasis.At present,we believe that abitrea mainly acts on the retinoic acid receptor on the surface of epidermal cells,and there are still relatively few studies on the non-receptor of psoriasis.In order to study the efficacy and mechanism of Acitretin in the treatment of plaque psoriasis,this article selected 80 patients with plaque psoriasis treated with Acitretin,and through questionnaires,regular follow-ups,and telephone return visits to understood them comprehensively.Including the patient’s conditions,clinical efficacy.And at the same time study its possible mechanism.Objective:To explore the clinical efficacy and possible mechanism of Acitretin single drug on the plaque psoriasis.Methods:1、Select 80 patients with plaque psoriasis that are in the clinical diagnosis,and give them oral Acitretin system treatment alone,20mg/d with lunch,and 30mg/d for those weighing ≥70kg,with the maximum dose not exceeding 50mg/d.According to the patients’ skin conditions to give them external use of moisturizer.Calculate BSA scores,DLQI,PASI scores of these plaque psoriasis patients,and the clinical efficacy of acitretin drugs was comprehensively analyzed by the decrease index of PASI score,the area of skin lesions and the improvement of the patient’s quality of life.2、Statistics and analysis of natural conditions of 80 patients with plaque psoriasis.3、Test liver and kidney function,blood routine,urine routine,blood sugar,and blood lipids before,during and after treatment to evaluate the adverse reactions and safety of Acitretin.4、Through telephone return visit to understand the patient’s recurrence within 3 months after stopping the drug.5、Observe the expression levels of serum cytokines IL-8,IL-22,and IL-36γbefore and after treatment.Results:1、The course of 80 patients’ disease was 15 days to 50 years.The pre-treatment PASI score of them was 1.5～57.0,with an average of 10.08±8.48.The effective time is 7 days to 35 days,with an average of 21.08±7.71 days.After two months’ treatment,67patients(83.8%)with skin lesions were improved.Among them,4 cases(5%)were cured,37 cases(46.3%)were significantly improved,26cases(32.5%)were efficacy,and 13 cases without treatment effect,accounted for16.2%.Among them,6 patients stopped medication for 15 days due to new rash or severe intolerance due to dry and burst skin during medication.The total effective rate was 51.3%.Using SPSS 25.0 to perform Wilcoxon rank sum test on the PASI score,BSA score and DLQI of 80 patients,before and after 8 weeks of treatment.The results showed that before and after treatment,there were significant differences in PASI score,BSA score and DLQI,and(P<0.01).After the application of Acitretin,the patient’s skin lesions and quality of life were significantly improved.And the better the curative effect,the greater the improvement of the patient’s quality of life.2、Adverse reactions: A total of 60 patients(75%)had adverse reactions.Most patients had two or more adverse reactions at the same time.There were 42 cases(52.5%)feel mouth and lip mucosa drying,25 cases(31.3%)feel skin drying and itching,13 cases with hair loss(16.3%),7 cases with skin redness(8.8%),4 cases with stomach upset and 4 cases with dyslipidemia(5.0%,respectively),5 cases feel fatigue(6.3%),3 cases(3.8%)with abnormal liver function and 1 case(1.3%)with arthralgia.For the above-mentioned adverse reactions,the corresponding symptomatic treatment and the reduction of acitretin were given,and the adverse reactions were all improved.3、Recurrence:Among 41 patients with effective treatment(cured add markedly effective patients),38 patients who had stopped the drug were interviewed by telephone.As a result,there were 12 patients(31.6%)recurrence after stopping the drug,of which 8 cases patients relapsed within 3 months,and 4 patients relapsed half a year.The remaining patients are still being followed up.For those who continue to choose oral Acitretin after recurrence,the effect is still definite.4、Natural conditions of patients: Among the 80 subjects,54 were males and26 were females.The ratio of male to female was 2.1:1.The patients were 18 to74 years old,with an average of 39.7±15.3 years old.The course of the disease was 15 days to 50 years.The age of first onset was 6-74 years old,of which 50cases(62.5%)were 18-45 years old,16 cases(20.0%)were younger than 18 years old,12 cases(15.0%)are 46-69 years old,and 2 cases(2.5%)are older than 69years;As the first part of disease,20 cases(25.0%)on the scalp,20 cases(25%)in the lower limbs,11 cases(11.3%)in the torso,8 cases(10.0%)in the upper limbs,4 cases(5.0%)in the elbow and knee joints,3 cases(3.7%)in the face,13 cases(16.3%)with multiple positions at the same time,3 cases(3.7%)with unknown position;For the first season,there were 24 cases(30.0%)happened in winter,followed by 18 cases(22.5%)in autumn.And 31 cases(38.8%)worsened in winter,at least,4 cases(5.0%)in summer;There were 7 cases of homomorphic reaction,6 cases of nail damage,1 case of joint symptoms.There were 15 cases(18.8%)combined with hypertension,coronary heart disease,diabetes,hepatitis B,syphilis,allergic diseases,tumors and other system diseases.Due to repeated episodes of the disease,4 cases were severely anxious.29 cases(36.3%)had family history,including 8 cases of first-degree relatives;59 cases(73.8%)of the patients were relapsed this time.The triggers of the disease are related by the mental stress,staying up late or poor rest,drinking or spicy food,colds,surgery or trauma,eating seafood or beef and mutton,eating greasy food,and humid environment.Among them,15 cases(18.8%)were caused by drinking or eating spicy food,at least,2 cases(2.5%)were caused by surgical or trauma.28 cases(35.0%)usually have mental stress,due to the stress,only 6 cases(7.5%)were induced disease.39 cases(48.8%)had no obvious predisposing factors.Mostly patients had bad habits,such as smoking,drinking,staying up late,dieting,etc.And there were 35 cases(43.8%)had a history of smoking,among them,34 cases were still smokers during disease,ranging from 3 to 20 cigarettes/day.9 cases(11.3%)had a history of drinking(≥1 time/week),mostly drank beer,fewer drank low-alcohol liquor.7 cases had the habit of staying up late;2 cases were on a diet;33 cases had unfavorable factors such as humidity,mosquitoes,flowers,and noisein the surrounding environment.5、The results of the experimental study showed that the expression levels of IL-8,IL-22,and IL-36γ in patients were detected were significantly higher than those of normal subjects.After treatment with Acitretin,the levels of IL-8and IL-22 in patients were significantly decreased.However,the change of expression level of IL-36γ after treatment was not statistically significant.Conclusion:1、Acitretin has obvious curative effect in the treatment of plaque psoriasis.The effective rate of treatment is 51.3%.After treatment,the skin lesions and quality of life of the patients have been improved.It has good safety,and at the same time,the side reaction can be controlled.Acitretin can be used as the first-line medication for the treatment of plaque psoriasis for a long term.2、The recurrence time of patients after stopping the drug ranges from 15 days to 6 months.Most(66.7%)of the recurrence time occurs within 3 months after stopping the drug,and a few(33.3%)appear within half a year.After recurrence,the treatment with Acitretin was applied again,and the effect was still sure.3、IL-8,IL-22,IL-36γ may be involved in the pathogenesis of plaque psoriasis.4、Acitretin can play A role by blocking the related pathways to inhibit IL-8and IL-22 inflammatory factors and improve the immune system function of patients.And it is believed that the regulation of IL-36γ was not involved in the mechanism of action.