Ruiz-Maldonado R, Tamayo L
Department of Pediatric Dermatology, National Institute of Pediatrics, Mexico City, Mexico.
Dermatologica. 1987;175 Suppl 1:125-32. doi: 10.1159/000248868.
During the last 10 years we treated 39 children with severe keratinization disorders with the aromatic retinoid etretinate. Six of these children were followed-up for 8-9 years. Mucocutaneous serum enzymatic and lipid side effects of etretinate were mild, transient and well tolerated. Osseous side effects were present after 4-6 years in all our 6 patients on prolonged retinoid therapy. Asymptomatic osseous neoformation and osseous reabsorption in the absence of calcium, phosphate, and alkaline phosphatase serum alterations have been observed. The growth and development curves and the sexual development of our patients (with exception of a patient with Rud's syndrome) have been normal. Osteoporosis and slender diaphysis were often present at initiation of therapy. On the basis of our findings and recent reports of the literature we suggest restricting retinoid therapy of keratinizing disorders in children to conditions severe enough to be physically, psychologically or socially incapacitating. In an attempt to reduce the risk of chronic toxicity and possibly to allow regression of initial bone alterations, intermittent therapy and combination therapy are recommended.
在过去10年里，我们用芳香维甲酸依曲替酯治疗了39例患有严重角化障碍的儿童。其中6名儿童接受了8至9年的随访。依曲替酯的皮肤黏膜、血清酶和脂质方面的副作用轻微、短暂且耐受性良好。在我们所有6例接受长期维甲酸治疗的患者中，4至6年后出现了骨骼方面的副作用。观察到在无血清钙、磷和碱性磷酸酶改变的情况下出现无症状性骨新形成和骨吸收。我们患者（除一名患有鲁德综合征的患者外）的生长发育曲线和性发育均正常。治疗开始时经常出现骨质疏松和骨干纤细。基于我们的研究结果和近期文献报道，我们建议将儿童角化障碍的维甲酸治疗限制在严重到足以导致身体、心理或社会功能丧失的情况下。为了降低慢性毒性风险并可能使初始骨骼改变消退，建议采用间歇疗法和联合疗法。
