Abstract:
Objective
To investigate the efficacy and safety of acitretin A in the treatment of children with generalized pustular psoriasis.
Methods
From January 2011 to January 2015, 12 children with pustular psoriasis were admitted to Hunan Children's Hospital were enrolled. All children were given acitretin A orally, at the initial dose of 0.4-0.8 mg / (kg·d), once daily. The same dose was maintained during the following two weeks of treatment, after which, the treatment effect was evaluated. If it was ineffective, the dose was increased according to the children's condition and the treatment was continued. If the skin lesion of children disappeared more than 90%, the dose was gradually reduced until it was stopped. The effect was assessed based on the skin lesion area and PASI scores before and after treatment; the GPT, albumin, triglyceride, of Ca2+and K+ were determined; the adverse reactions were observed and the relapse in children were analyzed.
Results
Eleven cases were cured and the treatment was markedly effective in 1 case, the total effective rate being 100.0%. PASI score was (1.5±1.4) points after treatment, which was significantly lower than that before treatment (7.8±2.1), the difference being statistically significant (P<0.05). After treatment the level of alanine aminotransferase and serum albumin was significantly higher than before treatment, while triglyceride level was significantly lower than before treatment, and the difference was statistically significant (P<0.05). There was no significant difference in the levels of Ca2+ and K+ of children before and after treatment (P>0.05). There were 6 cases of pruritus, 2 cases of mucous membrane dryness, 1 case of slight dyslipidemia, 3 cases of elevated liver enzymes, and 3 cases of embolism increased; the adverse reactions were mild in all the 12 cases; there was no significantly abnormal liver and kidney function, and the adverse reactions disappeared after symptomatic treatment (diet conditioning, changing the dosage, etc.), which did not affect the medication process. Children were followed up for 1 to 2 years, and a total of 5 cases of children relapsed, the recurrence rate being 41.7%.
Conclusion
Acitretin A has higher efficacy and safety in the treatment of children with generalized pustular psoriasis.

Key words: Generalized pustular psoriasis, Acitretin A, Efficacy, Adverse reactions, Children