Dermatology Department, Saint-Louis Hospital, Paris, France.
J Eur Acad Dermatol Venereol. 2011 May;25 Suppl 2:28-33. doi: 10.1111/j.1468-3083.2011.03993.x.
There is limited evidence regarding the efficacy and safety of retinoids in different psoriasis subtypes.
To systematically review the available literature on: (i) modalities of administration and prescription of oral retinoids as single agent or combined therapy for the treatment of plaque-type psoriasis (PV), nail psoriasis and localized and generalized pustular psoriasis : initial and optimal dosage; (ii) skeletal toxicity of retinoid for the treatment of psoriasis.
A systematic literature search was carried out in MEDLINE, EMBASE, and Cochrane Library databases from 1975 to 2010 searching for randomized controlled trials and observational studies evaluating 1) various dosages of retinoid in psoriasis and 2) skeletal toxicity of retinoid in psoriasis. Articles were limited to human subjects and English/French languages.
Efficacy of retinoids in psoriasis. Among 1348 identified references, 44 published studies were included. Starting daily dosages between 10 and 25 mg and stepwise escalation were associated with higher clinical efficacy and lower incidence of adverse events in comparison with higher doses and regimens rapidly reaching optimal dose. Retinoids as single agent therapy appeared to show limited efficacy in PV, while the good clinical efficacy reported in pustular forms should be cautiously considered, given the spontaneously remitting course of the disease. Combining retinoids with phototherapy appeared to be highly effective in patients with PV. Potential skeletal toxicity of retinoids. 15 published studies out of 105 identified references were included. There is no strong evidence of an increased risk of skeletal abnormalities in psoriasis patients treated with retinoids.
Acitretin appears to provide better efficacy in pustular psoriasis than in PV as a single agent treatment. There is no evidence for skeletal toxicity of retinoids in the setting of psoriasis, and accordingly monitoring this risk through X-ray is not warranted.
关于类视黄醇在不同银屑病亚型中的疗效和安全性，目前的证据有限。
系统回顾现有文献，评估：（i）作为单一药物或联合疗法治疗斑块型银屑病（PV）、甲银屑病和局限性及泛发性脓疱性银屑病的口服类视黄醇的给药和处方模式：初始和最佳剂量；（ii）治疗银屑病时类视黄醇的骨骼毒性。
从 1975 年至 2010 年，在 MEDLINE、EMBASE 和 Cochrane 图书馆数据库中进行了系统文献检索，检索评估 1）各种剂量的类视黄醇在银屑病中的应用和 2）类视黄醇在银屑病中的骨骼毒性的随机对照试验和观察性研究。文章仅限于人类受试者和英语/法语。
类视黄醇治疗银屑病的疗效。在 1348 篇鉴定的参考文献中，纳入了 44 项已发表的研究。与较高剂量和方案相比，起始日剂量为 10 至 25mg 并逐步增加与更高的临床疗效和较低的不良反应发生率相关。与其他治疗方案相比，作为单一药物治疗的类视黄醇在 PV 中显示出有限的疗效，而脓疱性银屑病中报告的良好临床疗效应谨慎考虑，因为这种疾病有自发缓解的过程。与光疗联合应用类视黄醇似乎对 PV 患者非常有效。类视黄醇的潜在骨骼毒性。从 105 篇已鉴定的参考文献中纳入了 15 项已发表的研究。在接受类视黄醇治疗的银屑病患者中，没有强有力的证据表明骨骼异常的风险增加。
阿维 A 酯作为单一药物治疗脓疱性银屑病的疗效优于斑块型银屑病。在银屑病的情况下，没有证据表明类视黄醇具有骨骼毒性，因此没有必要通过 X 射线监测这种风险。
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