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Etretinate Therapy for Generalized Pustular Psoriasis in Children

Etretinate Therapy for Generalized Pustular Psoriasis in Children Abstract • Two children, 19 months of age, were independently treated with a compassionate protocol of etretinate therapy for recalcitrant, debilitating pustular psoriasis. Laboratory test results, roentgenograms of the spine, and bone age were periodically monitored. Over a 3½-year period of intermittent treatment with a maximum dosage of 1.5 mg/kg/d, both children showed remarkable improvement with no apparent drug effect on growth and development. Side effects included xerosis, skin fragility and transient, minimal elevations of aspartate aminotransferase, lactic dehydrogenase, and triglyceride levels. Etretinate therapy may prove to be a viable treatment option for the child with intractable pustular psoriasis that seriously impairs quality of life. (Arch Dermatol 1987;123:230-233) References 1. Farber EM, Jacobs AH: Infantile psoriasis . AJDC 1977; 131:1266-1269. 2. Farber EM, Carlsen RA: Psoriasis in childhood . Calif Med 1966;105:415-420. 3. Blankenship M: Pustular psoriasis in a child . Arch Dermatol 1977;113:694. 4. Hubler WB: Familial juvenile pustular psoriasis . Arch Dermatol 1984;120:1174-1178.Crossref 5. Beylot C, Bioulac P, Grupper C, et al: Generalized pustular psoriasis in infants and children: Report of 27 cases , in Farber EM, Cox AJ (eds): Psoriasis: Proceedings of the Second International Symposium . New York, Yorke Medical Books, 1976, pp 171-179. 6. Zachariae H: Significance of the pustular reaction in psoriasis , in Farber EM, Cox AJ (eds): Psoriasis: Proceedings of the Second International Symposium . New York, Yorke Medical Books, 1976, pp 163-170. 7. Landry M, Muller SA: Generalized pustular psoriasis . Arch Dermatol 1972;105:711-716.Crossref 8. Hönigsmann H, Gschnait F, Konrad K, et al: Photochemotherapy for pustular psoriasis (von Zumbusch) . Br J Dermatol 1976;97:119-126.Crossref 9. Fisher I: Pustular psoriasis . Cutis 1970;6:1129-1134. 10. Baker H: Corticosteroids and pustular psoriasis . Br J Dermatol 1976;94:83-88.Crossref 11. Zachariae H, Kragballe K, Herlin T: Colchicine in generalized pustular psoriasis: Clinical response and antibody-dependent cytotoxicity by monocytes and neutrophils . Arch Dermatol 1982; 274:327-333.Crossref 12. Fredriksson T, Peterson U: Severe psoriasis: Oral therapy with a new retinoid . Dermatologica 1978;157:238-244.Crossref 13. Orfanos CE: Oral retinoids: Present status . Br J Dermatol 1980;103:473-481.Crossref 14. Dicken CH: Retinoids: A review . J Am Acad Dermatol 1984; 11:541-552.Crossref 15. Voorhees JJ, Orfanos CE: Oral retinoids . Arch Dermatol 1981;117:418-421.Crossref 16. DiGiovanna JJ, Peck GL: Oral synthetic retinoid treatment in children . Pediatr Dermatol 1983;1:77-88.Crossref 17. Traupe H, Happle R: Etretinate therapy in children with severe keratinization defects . Eur J Pediatr 1985;143:166-169.Crossref 18. Ellis CN, Madison KC, Pennes DR, et al: Isotretinoin therapy is associated with early skeletal radiographic changes . J Am Acad Dermatol 1984;10:1024-1029.Crossref 19. Pittsley RA, Yoder FW: Retinoid hyperostosis . N Engl J Med 1983;28:1012-1014.Crossref 20. Milstone JM, McGuire J, Ablow RC: Premature epiphyseal closure in a child receiving oral 13-cis retinoic acid . J Am Acad Dermatol 1982;7:663-666.Crossref 21. Sillevis Smitt JH, De Mari FR: A serious side effect of etretinate . Clin Exp Dermatol 1984;9:554-556.Crossref 22. Burge S, Ryan T: Diffuse hyperostosis associated with etretinate . Lancet 1985;2:397-398.Crossref 23. Tamayo L, Ruiz-Maldonado R: Long-term follow-up of 30 children under oral retinoid Ro 10-9359 , in Orfanos CE, Braun-Falco O, Farber EM (eds): Retinoids . New York, Springer-Verlag NY Inc, 1981, pp 287-294. 24. Gerber LH, Helfgott RK, Gross EG, et al: Vertebral abnormalities associated with synthetic retinoid use . J Am Acad Dermatol 1984;10:817-823.Crossref 25. Gluck S, Melnick B, Goerz G: Retrospective evaluation of skeletal radiographic changes after long-term etretinate therapy, abstracted . J Invest Dermatol 1986;86:326. 26. DiGiovanna JJ, Gerber LN, Helfgott RK, et al: Ligamentous calcification and bony spurring after chronic etretinate therapy , abstracted. J Invest Dermatol 1986;86:471. 27. Wolska H, Jablonska S, Langner A, et al: Etretinate therapy in generalized pustular psoriasis (Zumbusch type) . Dermatologica 1985;171:297-304.Crossref 28. Lorand T, Pierard-Franchimont C, de la Brassinne M: Treatment of generalized pustular psoriasis with Ro 10-9359 . Dermatologica 1983;167:159-160.Crossref 29. Christiansen JV, Holm P, Reymann F, et al: Patients' acceptance of etretinate therapy: A retrospective survey of long-term etretinate therapy in chronic keratotic and pustular skin diseases . Dermatologica 1984;168:122-126.Crossref 30. Van de Kerkhof PCM: Generalized pustular psoriasis in a child . Dermatologica 1985;170:244-248.Crossref 31. Presbury DGC: Intractable skin disorder treated with the aromatic retinoid etretinate . S Afr Med J 1984;65:501-502. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Etretinate Therapy for Generalized Pustular Psoriasis in Children

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References (41)

Publisher
American Medical Association
Copyright
Copyright © 1987 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1987.01660260100023
Publisher site
See Article on Publisher Site

Abstract

Abstract • Two children, 19 months of age, were independently treated with a compassionate protocol of etretinate therapy for recalcitrant, debilitating pustular psoriasis. Laboratory test results, roentgenograms of the spine, and bone age were periodically monitored. Over a 3½-year period of intermittent treatment with a maximum dosage of 1.5 mg/kg/d, both children showed remarkable improvement with no apparent drug effect on growth and development. Side effects included xerosis, skin fragility and transient, minimal elevations of aspartate aminotransferase, lactic dehydrogenase, and triglyceride levels. Etretinate therapy may prove to be a viable treatment option for the child with intractable pustular psoriasis that seriously impairs quality of life. (Arch Dermatol 1987;123:230-233) References 1. Farber EM, Jacobs AH: Infantile psoriasis . AJDC 1977; 131:1266-1269. 2. Farber EM, Carlsen RA: Psoriasis in childhood . Calif Med 1966;105:415-420. 3. Blankenship M: Pustular psoriasis in a child . Arch Dermatol 1977;113:694. 4. Hubler WB: Familial juvenile pustular psoriasis . Arch Dermatol 1984;120:1174-1178.Crossref 5. Beylot C, Bioulac P, Grupper C, et al: Generalized pustular psoriasis in infants and children: Report of 27 cases , in Farber EM, Cox AJ (eds): Psoriasis: Proceedings of the Second International Symposium . New York, Yorke Medical Books, 1976, pp 171-179. 6. Zachariae H: Significance of the pustular reaction in psoriasis , in Farber EM, Cox AJ (eds): Psoriasis: Proceedings of the Second International Symposium . New York, Yorke Medical Books, 1976, pp 163-170. 7. Landry M, Muller SA: Generalized pustular psoriasis . Arch Dermatol 1972;105:711-716.Crossref 8. Hönigsmann H, Gschnait F, Konrad K, et al: Photochemotherapy for pustular psoriasis (von Zumbusch) . Br J Dermatol 1976;97:119-126.Crossref 9. Fisher I: Pustular psoriasis . Cutis 1970;6:1129-1134. 10. Baker H: Corticosteroids and pustular psoriasis . Br J Dermatol 1976;94:83-88.Crossref 11. Zachariae H, Kragballe K, Herlin T: Colchicine in generalized pustular psoriasis: Clinical response and antibody-dependent cytotoxicity by monocytes and neutrophils . Arch Dermatol 1982; 274:327-333.Crossref 12. Fredriksson T, Peterson U: Severe psoriasis: Oral therapy with a new retinoid . Dermatologica 1978;157:238-244.Crossref 13. Orfanos CE: Oral retinoids: Present status . Br J Dermatol 1980;103:473-481.Crossref 14. Dicken CH: Retinoids: A review . J Am Acad Dermatol 1984; 11:541-552.Crossref 15. Voorhees JJ, Orfanos CE: Oral retinoids . Arch Dermatol 1981;117:418-421.Crossref 16. DiGiovanna JJ, Peck GL: Oral synthetic retinoid treatment in children . Pediatr Dermatol 1983;1:77-88.Crossref 17. Traupe H, Happle R: Etretinate therapy in children with severe keratinization defects . Eur J Pediatr 1985;143:166-169.Crossref 18. Ellis CN, Madison KC, Pennes DR, et al: Isotretinoin therapy is associated with early skeletal radiographic changes . J Am Acad Dermatol 1984;10:1024-1029.Crossref 19. Pittsley RA, Yoder FW: Retinoid hyperostosis . N Engl J Med 1983;28:1012-1014.Crossref 20. Milstone JM, McGuire J, Ablow RC: Premature epiphyseal closure in a child receiving oral 13-cis retinoic acid . J Am Acad Dermatol 1982;7:663-666.Crossref 21. Sillevis Smitt JH, De Mari FR: A serious side effect of etretinate . Clin Exp Dermatol 1984;9:554-556.Crossref 22. Burge S, Ryan T: Diffuse hyperostosis associated with etretinate . Lancet 1985;2:397-398.Crossref 23. Tamayo L, Ruiz-Maldonado R: Long-term follow-up of 30 children under oral retinoid Ro 10-9359 , in Orfanos CE, Braun-Falco O, Farber EM (eds): Retinoids . New York, Springer-Verlag NY Inc, 1981, pp 287-294. 24. Gerber LH, Helfgott RK, Gross EG, et al: Vertebral abnormalities associated with synthetic retinoid use . J Am Acad Dermatol 1984;10:817-823.Crossref 25. Gluck S, Melnick B, Goerz G: Retrospective evaluation of skeletal radiographic changes after long-term etretinate therapy, abstracted . J Invest Dermatol 1986;86:326. 26. DiGiovanna JJ, Gerber LN, Helfgott RK, et al: Ligamentous calcification and bony spurring after chronic etretinate therapy , abstracted. J Invest Dermatol 1986;86:471. 27. Wolska H, Jablonska S, Langner A, et al: Etretinate therapy in generalized pustular psoriasis (Zumbusch type) . Dermatologica 1985;171:297-304.Crossref 28. Lorand T, Pierard-Franchimont C, de la Brassinne M: Treatment of generalized pustular psoriasis with Ro 10-9359 . Dermatologica 1983;167:159-160.Crossref 29. Christiansen JV, Holm P, Reymann F, et al: Patients' acceptance of etretinate therapy: A retrospective survey of long-term etretinate therapy in chronic keratotic and pustular skin diseases . Dermatologica 1984;168:122-126.Crossref 30. Van de Kerkhof PCM: Generalized pustular psoriasis in a child . Dermatologica 1985;170:244-248.Crossref 31. Presbury DGC: Intractable skin disorder treated with the aromatic retinoid etretinate . S Afr Med J 1984;65:501-502.

Journal

Archives of DermatologyAmerican Medical Association

Published: Feb 1, 1987

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