Acitretin is a retinoid, which structurally similar to Accutane– which is known to cause severe meibomian gland dysfunction. I could not find a paper stating Acitretin causes meibomian gland issues but there has been no study to evaluate “acitretin’s long term effect on meibomian and lacrimal glands.
Acitretin can cause dry eyes and dryness of the mouth, nose, and throat according to the manufacturer. It’s pathophysiology is likely similary to how Accutane works, which makes all eyeMD’s nervous about patients who are using Acitretin.
The first
generation include:
1. Nonaromatic retinoids β-carotene
(provitamin A),
2. All-trans-retinoic acid (RA, tretinoin)
3. 13-cis-RA (Isotretinoin also known as Accutane): 1955 first synthesized; 1973 treatment started for psoriasis & acne in Europe. 1976 in US.
The second generation include:
1. Monoaromatic retinoids Etretinate: 1972 synthesized
2. Acitretin replaced Etretinate because of Acitretin long halflife. Bexarotene represents the third novel generation of
vitamin A analogs. It is the first retinoid or arotinoid that
selectively acts through the retinoid X receptors (RXRs) and
is mainly used in Cutaneous T-cell lymphoma (CTCL
The third generation include:
1. Polyaromatic retinoid derivatives tazarotenic acid
2. Adapalene
3. Bexarotene: first retinoid or arotinoid that selectively acts through the retinoid X receptors (RXRs) and is mainly used in Cutaneous T-cell lymphoma (CTC
For now, I would recommend against using Acitretin in any patient who has dry eye symptoms or Meibomian Gland Dysfunction until proper studies are performed to prove it is safe on Meibomian Glands.
SLC
References:
Ibrahim MAA, Elwan WM. Role of topical dehydroepiandrosterone in ameliorating isotretinoin-induced Meibomian gland dysfunction in adult male albino rat. Ann Anat 2017;211:78–87.
Perry MD, McEvoy GK. Isotretinoin: new therapy for severe acne. Clin Pharm 1983;2:12–19.
Fraunfelder FT, LaBraico JM, Meyer SM. Adverse ocular reactions possibly associated with isotretinoin. Am J Ophthalmol 1985;100:534–537.
Fraunfelder FT, Fraunfelder FW, Edwards R. Ocular side effects possibly associated with isotretinoin usage. Am J Ophthalmol 2001;132:299–305.
Caffery BE, Josephson JE. Ocular side effects of isotretinoin therapy. J Am Optom Assoc 1988;59:221–224.
Denis P, Nordmann JP, Saiag P, Liotet S, Laroche L, Saraux H. Chronic blepharoconjunctivitis during a treatment with acitretin (Soriatane). J Fr Ophtalmol 1993;16:191–194.
Mathers WD, Shields WJ, Sachdev MS, Petroll WM, Jester JV. Meibomian gland morphology and tear osmolarity: changes with Accutane therapy. Cornea 1991;10:286–290.
Bozkurt B, Irke M, Atakan N, Orhan M, Geyik P. Lacrimal function and ocular complications in patients treated with systemic isotretinoin. Eur J Ophthalmol 2002;12:173–176.
Gross EG, Helfgott MA. Retinoids and the eye. Dermatol Clin 1992;10:521–531.
Jaanus SD. Ocular side effects of selected systemic drugs. Optom Clin 1992;2:73–96.
Egger SF, Huber-Spitzy V, Bohler K, Raff M, Scholda C, Barisani T, et al. Ocular side effects associated with 13-cis-retinoic acid therapy for acne vulgaris: clinical features, alterations of tearfilm and conjunctival flora. Acta Ophthalmol Scand 1995;73:355–357