Indications & Dose: CONGENITAL ICHTHYOSIS Long-term therapy PO Adult 25-50mg/day 2-4 wk, titrate dose based on response max 50mg | DARIER’S DISEASE Long-term therapy PO Adult Initially 10mg/day titrate dose based on response max 50mg Child 1 month-12 yr: 500µg/kg/day max 35mg/day, 12-18 yr: Initially 10mg/day 2-4 wk, titrate dose based on response | HARLEQUIN ICHTHYOSIS PO Child Neonate: 500µg/kg/day | SEVERE PALMOPLANTAR PUSTULAR PSORIASIS Short-term therapy PO Adult Initially 25-50mg/day as single dose MD 25-50mg/day based on clinical efficacy & tolerability Child 1 month-12 yr: 500µg/kg/day max 35mg/day, 12-18 yr: Initially 25–30mg/day 2-4 wk, titrate dose based on response | SEVERE PSORIASIS Short-term therapy PO Adult Initially 25-50mg/day as single dose MD 25-50mg/day based on clinical efficacy & tolerability Child 1 month-12 yr: 500µg/kg/day max 35mg/day, 12-18 yr: Initially 25–30mg/day 2-4 wk, titrate dose based on response

Precautions: Hepatic/renal impairment, DM, obesity, elevated cholesterol/TG levels, elderly, alcoholism

ADR: Serious: depression, abnormal gait, nerve inflammation, pseudotumor cerebri, cataract, conjunctivitis, hearing loss, papilledema, pancreatitis, dysuria, atrophic vaginitis, leucorrhea, jaundice/hepatitis, spinal bone overgrowth, Others: hyperesthesia, paresthesia, headache, insomnia, drowsiness, fatigue, abnormal/blurred vision, dry eyes, eye irritation, reduced night vision, photophobia, earache, tinnitus, epistaxis, rhinitis, nausea, vomiting, diarrhea, constipation, abdominal pain, myalgia, gastritis, coughing, laryngitis, dry skin, pruritus, skin atrophy, tongue ulcers, gingival bleeding

DDI: Serious Methotrexate causes liver toxicity, Retinol leads to hypervitaminosis A, Alcohol may increase the serum levels of etretinate (drug metabolite)

Diet: with food

Monitor: Lipid profile (baseline, after 1-2 wks intervals 4-8 wks); LFTs, blood glucose (diabetic patients) bone abnormalities (long-term use)