This is a metabolite of etretinate

Indications severe resistant or complicated psoriasis, congenital disorders of keratinization including Darier's disease (keratosis follicularis).

Cautions: avoid in hepatic impairment, monitor liver function and plasma lipids (especially in patients with hypertriglyceridaemia) 1 month after initiating treatment and then at 3 monthly intervals. Exclude pregnancy before starting; patients should avoid pregnancy at least 1 month before, during and for at least 2 years after treatment; should avoid concomitant high doses of vitamin A and should not donate blood during or for 2 years after stopping therapy (teratogenic risk); radiographic assessment on long-term treatment; investigate atypical musculoskeletal symptoms; avoid long term use in children (skeletal hyperostosis and extra- osseous calcification).

Contra-indications: hepatic and renal impairment; pregnancy and breast-feeding.

Side Effects: (Mainly dose-related) dryness and erosion of mucous membranes, scaling, thinning erythema and pruritis of skin and conjunctiva; palmar and plantar exfoliation, epistaxis and epidermal fragility; paronychia, reversible alopecia; myalgia and anthralgia; nausea, headache, malaise, drowsiness and sweating; benign intracranial hypertension; raised liver enzymes, jaundice and hepatitis, raised triglycerides.

Dose: initially 25-30 mg daily for 2-4 weeks. Maintenance, 25-50 mg daily (may reach 75 mg in some cases) for further 6-8 weeks.

Child, (in very exceptional cases only) 500 mcg/kg. daily with careful monitoring of musculoskeletal development.