Efficacy and safety of acitretin monotherapy in children with pustular psoriasis: results from 15 cases and a literature review

BACKGROUND: There is a few evidence-based information regarding the efficacy and safety of acitretin treatment in children with pustular psoriasis (PP). OBJECTIVE: This study aimed to provide an additional evidence for this field. METHODS: A retrospective study was undertaken for 15 children with PP who received acitretin in doses of 0.6-1.0 mg/kg/day for 4-6 weeks, the transition dose of 0.2-0.4 mg/kg/day for 4-6 weeks and maintenance dose of 0.2-0.3 mg/kg/day. Additionally, a literature review on this topic is conducted. RESULTS: Of 15 children with generalized PP (GPP, n = 10), palmoplantar psoriasis (PPP, n = 3), and acrodermatitis continua of Hallopeau (ACH, n = 2), 93.3% (14/15) showed good response, only one case with ACH exhibited moderate response. During the 10-32 months of follow-up, acitrerin monotherapy for children cases with PP overall showed good efficacy and safety. In the literature review, a total of 107 childhood PP cases treated with acitretin in 21 studies were included in the analysis. The clinical effectiveness was obtained in 88.8% (95/107) patients treated with acitretin as monotherapy or combination therapy, and most of cases (92.6%, 100/107) treated by acitretin did not report side effects during the treatment and follow-up of acitretin. LIMITATION: This study is just included a small sample sizes and no standardized studies were used in the literature. CONCLUSION: Acitretin therapy for children with PP (monotherapy or combination therapy), all showed a satisfactory therapeutic effect and safety, independent of the short or long-tern therapeutic procedures.