Acitretin

[Shazbog]

Anyone take acitretin for hypertrophic lupus - what side effects are you having ?

[lupus-support1 Administrator]

Cutaneous Hypertrophic Lupus Erythematosus in a Patient With Systemic Involvement

Carla Cardinali, MD; Barbara Giomi, MD; Marzia Caproni, MD; Paolo Fabbri, MD

DISCLOSURES Skinmed. 2004;3(1)

Hypertrophic LE is a rare subset of chronic cutaneous LE and represents 2% of the total chronic cutaneous lesions of LE.[1,2] Hypertrophic LE is similar to discoid LE but with marked hyperkeratosis due to an exaggerated proliferative response. Typical discoid LE lesions can occur with hypertrophic LE.[3] A clinical course marked by chronicity and progression of the lesions characterize this subset, although systemic involvement is rare. Hypertrophic LE has been also referred to as verrucous LE,[4,5] hyperkeratotic LE,[6] keratotic LE,[7] and hypertrophic discoid LE,[2] and for this reason its incidence is probably undervalued.

This form consists of dull red, raised, indurated lesions covered by keratotic, multilayered, horny, white or yellow scales. These lesions commonly affect the extensor surface of the arms and legs, the upper back, and the face. When the palms and soles are involved, hypertrophic lupus produces localized or partially diffuse keratoderma.

According to the literature, hypertrophic LE lesions usually have hyperkeratotic and nodular features and therefore resemble keratoacanthomas or hypertrophic lichen planus.[5] The majority of the lesions observed in our patient (in the periungual areas) were erythematous-indurat-ed lesions with only a moderate hyperkeratosis, resembling typical discoid LE lesions. Only one lesion, located on the first finger of her right hand, presented a central keratotic plug. Although the diagnosis of hypertrophic LE was clinically suggestive, it was confirmed on histopathological examination showing marked acanthosis, hyperkeratosis, and degenerative changes of basal cells in addition to a pronounced cellular infiltrate in the upper dermis. Histologically, hypertrophic LE may resemble pseudocarcinomatous hyperplasia and even squamous cell carcinoma,[1,8] which needs to be considered in the differential diagnosis of these lesions. This distinction is particularly important in case of the rare development of squamous cell carcinoma in scarred areas of chronic cutaneous LE.[9]

Another interesting histological finding, observed in skin lesions secondary to hypertrophic LE, is the presence of localized amyloid deposition as has been reported in four recent cases.[10] In addition to the histopathological findings, the presence of immunological deposits along the basement membrane, viewed by immunofluorescence microscopy, supports the diagnosis of LE even in cases of uncommon verrucous lesions.[5]

Oral and ocular lesions are a characteristic sign of systemic LE. In fact, ulcerative lesions are an American College of Rheumatology criterion for the diagnosis of systemic LE.[11] In LE patients with systemic involvement, the onset of oral ulcerations usually correlates with disease flares[12] as in this case and another recently reported case with a maculopapular lupus rash.[13]

Asymptomatic dry eye is considered the most common ophthalmic manifestation of systemic LE, but sight-threatening complications such as retinal vaso-occlusive disease and optic neuropathy have been reported.[14] A case of hypertrophic discoid LE of the conjunctiva, resolved with hydroxychloroquine, has also been recently reported. A raised conjunctival mass could be detected in the context of refractory blepharoconjunctivitis in this case, suggesting that ophthalmic manifestations are not so uncommon.[15]

Hypertrophic LE is treatment resistant; intralesional corticosteroids generally give only transient thinning.[16] Successful treatment of hypertrophic LE has been demonstrated with etretinate,[17] isotretinoin,[18] and with thalidomide[19] in sporadic cases. Our case, with its peculiar association of hypertrophic cutaneous lesions with oral ulcerations and ocular involvement in a patient with a long history of systemic LE, had a good response to treatment with hydroxy-chloroquine and methylprednisone.

medscape.com/viewarticle/46...

Acitretin is used to treat severe psoriasis (abnormal growth of skin cells that causes red, thickened, or scaly skin). Acitretin is in a class of medications called retinoids. This medication is a retinoid used in the treatment of severe psoriasis and other skin disorders in adults.

[321Peace21]

I hope you receive the help you need. I honestly don't know if I lupus the test say no but my symptoms show other wise.