Acitretin: optimal dosing strategies

Acitretin is an oral synthetic retinoid effective in the treatment of psoriasis. As monotherapy, acitretin has been shown to be most effective in treating pustular and erythrodermic types of the disease. Monotherapy with acitretin for plaque-type psoriasis is often less successful; however, its use in combination with other therapies is highly effective in treating this form of the disease. Dose-response studies have established the effective dose range of acitretin as well as the dose-dependence of its side effects. Because both efficacy and side effects can vary substantially among individual patients, proper dosing of acitretin requires a balance between optimizing response and minimizing toxicity for each patient. Optimal dosing for individual patients may be achieved through a dose-escalation strategy involving initiation of therapy at low doses (10 to 25 mg/day) and, if necessary, gradually increasing the dose as tolerated until optimal response is achieved.