Yu Chenyang, Wu Chao, Yang Yuyan, Jin Hongzhong
Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China.
Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, No. 1 Shuai Fu Yuan Street, Beijing 100730, China.
Ther Adv Chronic Dis. 2023 Jun 20;14:20406223231178412. doi: 10.1177/20406223231178412. eCollection 2023.
Erythrodermic psoriasis (EP) remains challenging to manage because it is rare and has complex complications. Although acitretin is recommended as an appropriate choice for EP, there is a lack of large-scale evidence.
This study aims to assess the efficacy and safety of acitretin as systemic monotherapy in EP patients.
We retrospectively analyzed data from patients with EP who received at least 3 months of acitretin as systemic monotherapy during hospitalization and out-patient follow-up from January 2005 to May 2021 at the Peking Union Medical College Hospital, China.
The efficacy was clinically evaluated after 1, 2, 4, and 12 weeks of treatment, which was classified as a good response (>75% of lesions cleared), partial response (50%-75% cleared), moderate response (25-50% cleared), or no response (<25% cleared). Safety was assessed on the basis of physical examination results and significant changes in laboratory examination results after 12 weeks of treatment.
Overall, 81 patients (79.0% men; mean age, 47.9 years) were included. The acitretin dose ranged from 20 to 60 mg/day (0.3 to 0.8 mg/kg/day). The rates of good, partial, and moderate responses were 0.0%, 2.5%, and 42.0% at 1 week; 3.7%, 34.6%, and 61.7% at 2 weeks; 29.6%, 58.0%, and 12.4% at 4 weeks; and 85.2%, 13.6%, and 1.2% at 12 weeks after treatment initiation, respectively. EP patients transformed from psoriasis vulgaris showed a higher good/partial response rate compared with that of EP patients that developed from pustular or articular psoriasis (44.6% 14.3%, = 0.035). Patients with concurrent infection showed a lower rate of good/partial response compared with that of those without concurrent infection (16.7% 44.4%, = 0.049). Adverse effects were seen in 45 (55.6%) patients in 12 weeks, and dyslipidemia ( = 31; 38.3%), xerosis ( = 24; 29.6%), and elevated liver enzymes ( = 6; 7.4%) were most commonly reported. Twenty-three patients were followed up for over 3 years, and six (26.1%) patients had EP recurrence.
Acitretin as a systemic monotherapy showed satisfactory effectiveness for EP, especially in patients developed from psoriasis vulgaris and without infection.
红皮病型银屑病（EP）的治疗仍然具有挑战性，因为其较为罕见且并发症复杂。尽管阿维A被推荐为EP的合适治疗选择，但缺乏大规模证据。
本研究旨在评估阿维A作为系统性单一疗法治疗EP患者的疗效和安全性。
我们回顾性分析了2005年1月至2021年5月在中国医学科学院北京协和医院住院及门诊随访期间接受至少3个月阿维A系统性单一疗法治疗的EP患者的数据。
在治疗1、2、4和12周后对疗效进行临床评估，分为良好反应（>75%的皮损消退）、部分反应（50%-75%消退）、中度反应（25%-50%消退）或无反应（<25%消退）。根据治疗12周后的体格检查结果和实验室检查结果的显著变化评估安全性。
共纳入81例患者（男性占79.0%；平均年龄47.9岁）。阿维A剂量范围为20至60mg/天（0.3至0.8mg/kg/天）。治疗1周时，良好、部分和中度反应率分别为0.0%、2.5%和42.0%；2周时分别为3.7%、34.6%和61.7%；4周时分别为29.6%、58.0%和12.4%；治疗开始后12周时分别为85.2%、13.6%和1.2%。寻常型银屑病转变而来的EP患者的良好/部分反应率高于脓疱型或关节型银屑病转变而来的EP患者（44.6%对14.3%，P=0.035）。合并感染的患者的良好/部分反应率低于未合并感染的患者（16.7%对44.4%，P=0.049）。12周内45例（55.6%）患者出现不良反应，最常见的是血脂异常（n=31；38.3%）、皮肤干燥（n=24；29.6%）和肝酶升高（n=六；7.4%）。23例患者随访超过3年，6例（26.1%）患者出现EP复发。
阿维A作为系统性单一疗法对EP显示出令人满意的疗效，尤其是对于由寻常型银屑病转变而来且未合并感染的患者。
