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Systemic retinoids in the management of ichthyoses and related skin types

Authors

  • John J. DiGiovanna,

    Corresponding author
    • DNA Repair Section, Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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  • Theodora Mauro,

    1. Department of Dermatology, San Francisco Veterans Administration Medical Center, San Francisco, California
    2. Department of Dermatology, University of California, San Francisco, California
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  • Leonard M. Milstone,

    1. Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
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  • Matthias Schmuth,

    1. Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria
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  • Jorge R Toro

    1. Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
    2. Department of Dermatology, Washington DC Veterans Administration Medical Center, Washington, DC
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  • This research was supported in part by the Intramural Research Program of the NCI, NIH, Medical Research Fund Tirol (MFF71, MFF153), the Austrian Science Fund (FWF J1901-MED, J2112-MED, P16990-B05), the European Cooperation in Science and Technology (COST Action BM0903)”

Address correspondence and reprint requests to: John J. DiGiovanna, MD, DNA Repair Section, Dermatology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, or email: jdigiova@mail.nih.gov.

Abstract

The term retinoid includes both natural and synthetic derivatives of vitamin A. Retinoid-containing treatments have been used since ∼1550BC by the early Egyptians. Treatment of ichthyosiform disorders with retinoids dates back at least to the 1930s. Early use of high-dose vitamin A demonstrated efficacy, but because vitamin A is stored in the liver, toxicity limited usefulness. Interest turned to synthetic retinoids in an effort to enhance efficacy and limit toxicity. Acetretin, isotretinoin and, in the past etretinate, have provided the most effective therapy for ichthyosiform conditions. They have been used for a variety of ages, including in newborns with severe ichthyosis and for decades in some patients. Careful surveillance and management of mucous membrane, laboratory, skeletal, and teratogenic side effects has made systemic retinoids the mainstay of therapy for ichthyosis and related skin types.

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