Clutch for Korman
The retinoid that is first line therapy for acral or generalized pustular psoriasis
Acitretin
- Also used in erythrodermic psoriasis without a rebound flare when discontinuing
The only retinoid found to suppress sebum production
Isotretinoin
This toll-like receptor is inhibited by retinoids
TLR2, which is important in inflammation
Daily Double!
The 6 baseline labs prior to initiating oral bexarotene
Decreased secretion from this gland after using isotretinoin results in patients unable to tolerate contact lenses
Meibomian glands
This is the upper limit of TGs when patients are taking isotretinoin
>800mg/dl
- Increased risk for pancreatitis
The minimum cumulative dose of isotretinoin to reduce post-therapy relapse of acne
120mg/kg.
- no further therapeutic gain beyond 150mg/kg (per Bolognia)
- JAMA Derm Blasiak et al: >220mg/kg over 12 months showed benefit
The two nuclear binding receptors for retinoids
Retinoic acid receptors (RARs) and Retinoid X receptors (RXRs)
The medication that should be started 7 days prior to oral bexarotene therapy. It increases HDL among other effects
Fenofibrate (145-200mg daily)
- Goal TG <200 and HDL >50mg/dl
All of the systemic retinoids are metabolized by this system
Hepatic
- All are excreted through biliary and renal (most)
This is the reason why males are registered through iPledge
There are no reported cases of male-associated birth defects, however cases have been reported where the female partner has borrowed medication
This organism colonizes those who have received therapy with isotretinoin
Staph aureus
Retinol is transported in plasma by binding to a complex of retinol binding protein and this protein
Transthyretin
This topical gel can be used for cutaneous Kaposi sarcoma
Alitretinoin 0.1% gel
- Oral version is available outside US
This type of collagen is boosted by 80% when using tretinoin
Type 1 Collagen
Korman wouldn't eat this, but you should if you are taking isotretinoin
A fatty meal
Daily Double!
The reason why a patient sheds hair after initiating isotretinoin. (Hint- it is not the "flu")
The use of this statin is contraindicated with bexarotene
Simvastatin (interacts with CYP 3A4, which alters bexarotene's metabolism)
- Same goes for Gemfibrozil: bexarotene is metabolized by cytochrome P450 3A4; avoid with gemfibrozil as it inhibits 3A4 → ↑plasma levels of bexarotene
The starting dose of oral bexarotene
150mg/m^2
- After 4 weeks increase to 300mg/m^2
Retinaldehyde functions biologically as a vitamin A derivative for benefit this organ
Visual Function
Conversion of acitretin to this alternative is the reason why patients should avoid alcohol during therapy
Etretinate (hepatotoxic)
- Larsen et al: Of the 86 patients, 30 had detectable plasma etretinate levels. No etretinate was found in 20 patients who reported that they never drank alcohol, while etretinate was found in all 16 patients with an average weekly alcohol consumption of > 200 g ethanol, corresponding to about 15 U (1 U equals half a pint of standard beer or a wine glass of non-fortified wine). Etretinate was detected in 14 of 50 patients with a moderate weekly alcohol intake of up to 200 g ethanol.
The first examination finding a physician (probably not a derm) should look for when an isotretinoin patient complains of persistent headache
Papilledema (fundoscopy)
- Examination for papilledema should be performed immediately when a patient receiving retinoid therapy complains of a persistent headache, especially if it is accompanied by visual changes, nausea or vomiting, or when pseudotumor cerebri is suspected
This is the specific type of hypothyroidism while taking bexarotene
Central hypothyroidism (occurs in 80% on bexarotene)
•Decreased TSH and T4
•Is reversible
•Current recommendations are to start low-dose levothyroxine in all patients
This type of leukemia may use oral tretinoin as a therapy
Acute Promyelocytic leukemia
- Oral tretinoin is an important component of therapeutic regimens for acute promyelocytic leukemia, where its ability to promote cellular differentiation is utilized.
In an otherwise healthy appearing neonate exposed to isotretinoin in-utero, this complication will likely result later in life
↓mental function becomes apparent in majority of these children over time: 30% have gross mental retardation and 60% have mild-moderate mental deficits