[Prescription of retinoids in psoriasis]

Systemic retinoids inhibit keratinisation and have anti-inflammatory properties. In 30 years, they have revolutionised numerous aspects of dermatological practice, particularly in the management of psoriasis. In the management strategy of severe psoriasis, acitretin has first place of the medications currently available. It is the on-going treatment par excellence. It is even more effective and better tolerated when doses are progressively increased in steps to reach the optimal effective dose that corresponds to the maximum tolerated dose. The dose is adjusted according to this tolerance and not to standardise doses. With this precondition, the secondary effects are benign, sometimes bothersome with an increasing fragility of the mucous membranes of the epithelia and the phaneres, bearing witness to the medication impregnation of tissues and the interference with the natural retinoids. Due to their teratogenic risk, the only restriction concerns women of childbearing age in whom all prescription of retinoids is subject to some legal considerations that are indispensable to respect.