alitretinoin

Alitretinoin, also known as 9-cis-retinoic acid, is a retinoid used in dermatology. It exists in oral form and as a topical gel; the topical formulation is marketed for Kaposi's sarcoma, while the oral form is used in some regions to treat severe chronic hand eczema that has not responded to potent topical corticosteroids. Regulatory approval for its use in chronic hand eczema varies by country.

Mechanism of action: Alitretinoin acts as an agonist at both retinoic acid receptors (RARs) and retinoid X receptors (RXRs). Through these nuclear receptors, it modulates gene expression to influence keratinocyte differentiation, immune responses, and inflammatory processes, which can help reduce hyperkeratosis and inflammation in affected skin.

Safety and cautions: Alitretinoin is teratogenic. Women of childbearing potential must use effective contraception and follow pregnancy prevention guidelines where applicable, including regular pregnancy testing. Common adverse effects include mucocutaneous dryness (lips and skin), headaches, and symptoms related to lipid and liver function changes. Patients should be informed about potential lipid elevations and liver enzyme abnormalities and monitored accordingly.

Monitoring and contraindications: Prior to and during treatment, clinicians typically monitor liver function tests and lipid panels, and assess overall tolerability and adherence to safety recommendations. Caution is advised in individuals with preexisting liver disease or significant dyslipidemia. Sun exposure should be minimized due to possible photosensitivity. As with all retinoids, use during pregnancy is contraindicated, and care should be taken to avoid pregnancy during and for a period after treatment, as advised by local guidelines.