Etretinate in severe psoriasis. Results of double-blind study and maintenance therapy in pustular psoriasis

A randomized double-blind study was performed in forty patients with severe psoriasis. Etretinate, in contrast to placebo, clearly reduced the psoriatic area and severity index score, and this difference was statistically significant from week 2. The results in psoriasis vulgaris were satisfactory in only three of ten patients; however moderate improvement was noticed in four of ten patients. In pustular psoriasis of von Zumbusch type, the drug produced moderate improvement to complete clearing in all four of the treated patients and was regarded as the first-choice therapy in all of them. In erythrodermic psoriasis satisfactory results were obtained in four of six patients. In three of the five patients with psoriatic arthropathy there was a marked improvement of arthralgia. Laboratory investigations did not show significant abnormalities with the exception of an increase of alanine transaminase (ALT; SGPT) in about 20% of the patients. Ten patients with pustular psoriasis (four of them included in the double-blind trial) on long-term, i.e., maintenance, therapy remained free of lesions up to this writing for 3 years. Triglyceride levels were not elevated.