Alitretinoin

Last updated on: 29.10.2020

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Synonym(s)

9-cis-retinoic acid

Definition
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Retinoid.

Effects
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  • Endogenous, physiological ligand and sole panagonist for retinoic acid receptor (RAR) and retinoid X-receptor (RXR). The activated receptors act as transcription factors that regulate gene expression, which in turn regulates cell differentiation and proliferation in healthy and neoplastic cells. In vitro, alitretinoin can inhibit the growth of Kaposi sarcoma cells. The exact mechanism of action in vivo is not known.
  • Anti-inflammatory effect in the skin by inhibiting cytokine production in keratinocytes. Inhibition of leukocyte activity and inhibition of chemotaxis mediated by leukocytes and antigen-presenting cells (APC) with downregulation of chemokines and other molecules important for the immune response (immune modulation).

Indication
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  • Treatment of severe therapy-resistant chronic hand eczema.
  • Treatment of skin lesions in patients with HIV-related Kaposi's sarcoma when the lesions are not ulcerated or lymphedematous, treatment of systemic Kaposi's sarcoma lesions is not required, the lesions do not respond to systemic antiretroviral therapy, and radio- or chemotherapy is not adequate.
  • There are individual case reports of success in Darier's disease.

Pregnancy/nursing period
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Contraindicated.

Dosage and method of use
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  • Panretin: Kaposi's sarcoma: Apply initially 2 times/day, then 2-4 times/day thickly to each lesion. Therapy over 12 weeks. Skin lesions that respond to topical therapy with alitretinoin will continue to be treated.
  • Toctino: Chronic hand eczema: The preparation is effective at a dosage of 10-30 mg/day p.o. Depending on the clinical findings, a reduction to 10 mg/day can be made.

Undesirable effects
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  • Topical: In up to 70% of patients erythema, oedema or blistering at the application site.
  • With oral medication: desiccation of the skin and mucous membranes, especially cheilitis simplex; rhinitis, dermatitis, headaches, trigyceride rises, hair curl.

Preparations
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  • Topical: Panretin gel.
  • Systemic: Toctino.

Note(s)
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According to the findings of the BACH study, alitretinoin can also be used in long-term therapy.

Literature
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  1. Barnstedt SE (2012) Successful therapy of Darier's disease with alitretinoin. Dermatologist 63:139-141
  2. HerinkC(2015) Hair curl under systemic therapy with alitretinoin. dermatologist 66: 617-619
  3. Molin S, Ruzicka T (2008) Alitretinoin. dermatologist 59: 703-709
  4. Ruzicka T (2010) Alitretinoin can also be used in long-term therapy. Results of a trade press conference in July 2010 in Munich. Act Dermatol 36: 494
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Last updated on: 29.10.2020