Are the clinical indications for acitretin the same as for isotretinoin?

No. While both drugs are orally administered retinoids, and they have many of the same therapeutic effects, they also demonstrate significant differences. As a general rule, isotretinoin is more effective in follicular disorders (e.g., acne vulgaris, rosacea, gram-negative folliculitis), and acitretin is more effective in pustular psoriasis and chronic pustular eruptions of the palms and soles. They appear to be of equal efficacy in disorders of keratinization, such as the ichthyoses and pityriasis rubra pilaris, although good comparative studies are lacking.

Acitretin is FDA-approved only for the treatment of severe recalcitrant psoriasis. It is especially effective for pustular and erythrodermic psoriasis. It is often used as monotherapy in these variants but also may be used in conjunction with other forms of therapy such as psoralen plus ultraviolet light, type A (PUVA) in plaque-type psoriasis. Like isotretinoin, acitretin has been used in many other cutaneous diseases (Table 56-5).

Table 56-5. Therapeutic Applications of Oral Acitretin
	FDA-APPROVED INDICATIONS		SELECTED NONAPPROVED APPLICATIONS
	Severe recalcitrant psoriasis		Granuloma annulare, generalized Ichthyoses (e.g., ichthyosis vulgaris) Keratosis follicularis (Darier’s disease) Mycosis fungoides (cutaneous T-cell lymphoma) Palmar/plantar pustulosis Pityriasis rubra pilaris Porokeratosis Subcorneal pustular dermatosis