Efficacy

High-dose retinoid versus placebo for induction of remission

The review identified four RCTs involving 127 people. Twenty-six of 67 (39%) patients who received etretinate (modal dose 1 mg/kg/day) as compared with 10 of 60 (17%) who received placebo achieved a good or excellent response (intention-to-treat analysis) with a success rate difference of 0-22 favouring retinoids (CI 0-07 to 0-36).

Low-dose retinoid versus placebo for maintenance of remission

The review found two RCTs involving 45 people. Thirteen of 21 (62%) who had responded to initial

How effective are treatments for chronic palmoplantar pustular psoriasis?

high dose (1 mg/kg/day) etretinate therapy maintained clinical remission for 3 months with low-dose etretinate (20-30 mg daily) as compared with five of 24 (21%) who received placebo. Success rate difference was 0-42 in favour of etretinate (CI 0-16 to 0-68).

Acitretin versus etretinate

One RCT (n = 60) found no difference in efficacy of the two retinoids as judged by reduction in pustule counts.

Versus PUVA

Two RCTs involving 121 people compared etretinate with PUVA (both topical and systemic). Seventeen of 43 (40%) cleared with retinoid compared with seven of 78 (9%) who received PUVA. The success rate difference was 0-38 in favour of retinoid therapy (CI 0-21 to 0-54).

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