Alitretinoin

Complete blood count, liver values, kidney values, lipids, pregnancy test, TSH.

p.o. with a meal.

30 mg (faster and better response), for adverse reactions: 10 mg.

Hypothyroidism, hyperlipidemia, combination with MTX (increased hepatotoxicity), combination with St. John's wort (interaction with hormonal contraceptives), combination with vitamin A or other retinoids (hypervitaminosis), possibly UV protection SPF 15, depression/suicidality, possibly worsening by alitretinoin. Avoid tetracyclines due to pseudotumor cerebri.

Pregnancy/breastfeeding (up to 1 month after discontinuation of treatment), liver/kidney insufficiency, uncontrolled hyperlipidemia, uncontrolled hypothyroidism, combination with tetracycline (pseudotumor cerebri), hypervitaminosis A.

Dose-dependent adverse reactions -> dose reduction to 10 mg, headache (24 %) -> analgesics, facial flushing, increased lipid levels -> lipid reducers, central hypothyroidism (T4 and TSH decreased), cheilitis/conjunctivitis -> refatting, artificial tears, no contact lenses.

12 weeks, with good response, treatment may be extended to 24 weeks, cycle repetition in case of relapse.