Accepted Article Correspondence Article type : : 18-Nov-2015 Accepted Date Research : 04-Oct-2015 LetterRevised Date Received : 11-Jun-2015 Date This This article is protected by copyright. All rights reserved. 10.1111/bjd. doi: todifferenceslead between this versionand Version the of Record. Please thiscite article as throughbeen the copyediting, typesetting, pagination and proofreading process, maywhich articleThis has been acceptedpublication for andundergonepeer full review buthasnot Funding sources: IRB approval: Contraception Keywords: Type ofstudy: Alitretinoin: treatment for refractory palmoplantar keratoderma Department ofDepartment Dermatology, Hanyang UniversityCollege ofMedicine,Korea Seoul, Alitretinoin; Acitretin; Mal Palmoplantar Side dekeratoderma; Meleda; effects; Clinical trial (Therapeutic trial in one patient) patient) in one trial (Therapeutic trial Clinical Not required.
14327 :Joo Yeon Ko, MD. PhD. E-mail: E-mail: Telephone: +82-2-2290-8441, Fax: +82-2-2291-9619 DepartmentAddress: of Dermatology,Hanyang UniversityHospital, None. [email protected] eu,1372 ot oe. Seoul, 133-792, South Korea. H.K. Park, E.J. Kim, J.Y. Ko J.Y. Kim, E.J. Park, H.K.
Accepted Article well-known adverse effects, such dryness, as teratogenicity and liver toxicity. replacement. reduced (Fig. 2a, 2b). In sheaddition, reported less mucocutaneous side effects after drug improved significantly. Especially, the extent thicknessand of hyperkeratosis were markedly After 3 alitretinoin. months of withtreatment her 30 alitretinoin mg/day, signs and symptoms discomfort and theneedof a long period of contraception, acitretin was replacedby new most of lesions did not show significant changes (Fig. 1a, 1b). Due to mucocutaneous cosmetic concerns.A palmoplantar modest improvement of hyperkeratosiswasobserved, but oralmonths, acitretin, 10 or 20 mg/day,was administered additionally because her increased topical steroid,ointments, and topical and sy frequent recurrence of athlete’s foot with malodor. Previous treatments included keratolytic totheextendeddorsal surfaces of the hands and feet sincebirth.also She complained of for MDM. that etretinate andacitretin, whichare aromaticretinoids, are effectivetreatment modalities 1 in ourpreviousreport, 1 keratoderma caused byin mutations the ARSgene,encoding SLURP-1. EDITOR, DEAR Running head: Prior presentation: N of interest: Conflicts This This article is protected by copyright. All rights reserved. A 20-year old woman, diagnosed oldwoman,A 20-year bywith identification MDM of gene mutation SLURP- in 2 However, early andlong-term use of these retinoids are associated with several
Alitretinoin: treatment forAlitretinoin: refractory keratoderma palmoplantar Mal de Meleda (MDM) is(MDM) de an palmoplantarform Mal Meleda recessive of autosomal None. one declared. 1 presentedwhich with hyperkeratosis extensive palmoplantar stemic antifungal agents. Over the past 30 1 It has been reported reported has been It 1 Accepted Article of leukocyte activation. leukocyte of retinoids,to other by directly affecting cytokine production in keratinocyte suppression and thought tohave and compared more potent properties immunomodulatory anti-inflammatory women of childbearing age. childbearing of women after therapy is completed, so it is considered effects than other retinoids. In addition, alitretinoin only requires 1month of contraception epidermal cell proliferation, differentiationepidermal proliferation, cell and cornification. reports somebeen ontheefficacy of acitretin in MDM. genetic disorder,rare no treatment protocolstandardized beenyet has established.have There severe forms of the keratoderma. of the forms severe pinfrrfatr ampatrkrtdra nldn D. palmoplantarrefractoryoption includingfor MDM. keratoderma, thereinforces concept be thatalitretinoin new, acould effective andpromising treatment forms of keratoderma,andher lesions showed a greaterimprovement. In conclusion, our case Byalitretinoin. comparison, ourpatient is anunmarried 20-year-old womanseverewithmore with hereditary palmoplantarpunctate keratoderma, showing significant improvement with to spontaneousto amputation ofdigits, the which justifies interventions.early This This article is protected by copyright. All rights reserved. hepatotoxicity andhepatotoxicity lipid derangement. useprolonged of and retinoids isasscociated withseveral adverse effects suchcheilitis, as treatment. women taking acitretin should use contraception for 2-3 years after discontinuation of receptors (RAR) A and X, Alitretinoin ( Alitretinoin
Advanced lesions ofMDM may show of conical tapering the fingertips, leading sometimes 3 9-cis-retinoic acid 5 Alitretinoin Alitretinoin alsois knownoccurless to mucocutaneous adverse
in contrast to acitretin which binds to only RAR A. 4,5 Recently, Raone etal. )is novela pan-agonist which retinoid, binds to retinoic acid
In a variety of disorders of keratinization, it normalizes normalizes it keratinization, of disorders of a In variety 2,3 2,3 Especially, because of the teratogenicity of acitretin, acitretin, of teratogenicity the of because Especially, a beneficial alternative of treatment acitretin for 4 reported a case of 41-year old woman woman old 41-year of case a reported 1,2 Acitretin has been used treatingfor 3 Importantly, however, early 1 Since MDM is MDM a Since 4 Alitretinoin is Accepted Article This This article is protected by copyright. All rights reserved. palmoplantar hyperkeratosis decrease of thickness and extent the alitretinoin, with treatment of 3 months 2. After Figure replacement. drugbefore (b) soles (a) and palms 1.Figure Patient showed waxy ivory-yellow, palmoplantar plaqueshyperkeratotic on both Legends Figure 5. 3. 2. 1. 4. References RAR: retinoic acid receptors MDM: Mal de Meleda used Abbreviations
Dermatol palmoplantar keratoderma (Brauer-Buschke-Fischerpunctate syndrome). B,Raone Raboni R, A. Patrizi Alitretinoin: A new treatment option hereditary for Ortiz NE,Nijhawan RI, Weinberg de Meleda. mal Van de PCM,Kerkhof Van Dooren-Greebe RJ, Steijlen Acitretin PM. in the treatment of in SLURP-1 inKorea. LeeOh YJ, HE, Ko JY et al. A SporadicCase ofde Mal Meleda caused bygenemutation 2012; clinicalpharmacokinetics pharmacodynamics. and Schmitt-Hoffmann AH, Roos B, Schoetzau A et 5 :373 2014; – 88. 71 Br J Dermatol :e48-9.
Ann Dermatol 1992; akdy epciey(,d. dd). markedly, (c, respectively JM. Acitretin. Dermatol Ther 2013; Ther Dermatol JM. Acitretin. 127 2011; :191-2. 23 :396-9. al. Oralalitretinoin: review ofthea Expert Rev Clin Pharmacol 26 :390-9. J AmAcad Accepted Article This This article is protected by copyright. All rights reserved.