Effects of Acitretin Treatment on Hearing in Patients with Psoriasis Vulgaris

Year 2022, Volume: 32 Issue: 4, 92 - 100, 24.01.2023

Başak Mutlu , Merve Torun Topçu , Ayse Serap Karadag , Ayşe Yasemin Gündüz , Tayyar Kalcıoğlu

https://doi.org/10.26650/Tr-ENT.2022.1207615

Abstract

Objective: In this study, we aimed to compare the hearing thresholds and outer hair cell functions of patients with psoriasis vulgaris (PV) with healthy individuals and to investigate the ototoxic effects of acitretin treatment (AT) in patients with PV. Materials and Methods: This study included 23 patients with PV who required treatment with acitretin as well as 23 healthy individuals. Conventional and extended high-frequency pure-tone audiometry and transient-evoked otoacoustic emission tests were performed at regular intervals during the 24 weeks of acitretin treatment. Results: During the acitretin treatment for the PV group, the hearing thresholds of 4,000 Hz (right ear, p=0.004) presented a significant difference that did not have a worsening effect. The signal-to-noise ratios of TEOAE did not show a significant difference. At 24 weeks of AT, the changes in the hearing thresholds (4,000 Hz) and TEOAE signal-to-noise ratios did not indicate any worsening owing to acitretin. According to the ASHA criteria, there was no significant evidence of ototoxicity related to acitretin. According to the TUNE ototoxicity grading system, it was seen that at 24 weeks of AT, all the patients with psoriasis were scored as grade 0 (no hearing loss). Conclusion: This study showed that acitretin does not have an ototoxic effect when it is used to treat PV in the recommended treatment doses.

Keywords

Acitretin, high-frequency hearing, ototoxicity, psoriasis vulgaris

Supporting Institution

None

Project Number

None

References

• 1. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol 2013;133(2):377-85. google scholar
• 2. Pariser DM, Bagel J, Gelfand JM, Korman NJ, Ritchlin CT, Strober BE, et al. National Psoriasis Foundation. National Psoriasis Foundation clinical consensus on disease severity. Arch Dermatol 2007;143(2):239-42. google scholar
• 3. Pilkington T, Brogden RN. Acitretin. A review of its pharmacology and therapeutic use. Drugs 1992;43(4):597-627. google scholar
• 4. Lee CS, Li K. A review of acitretin for the treatment of psoriasis. Expert Opin Drug Saf 2009;8(6):769-79. google scholar
• 5. Ortiz NE, Nijhawan RI, Weinberg JM. Acitretin. Dermatol Ther 2013;26(5):390-9. google scholar
• 6. Magis NL, Blummel JJ, Kerkhof PC, Gerritsen RM. The treatment of psoriasis with etretinate and acitretin: a follow up of actual use. Eur J Dermatol 2000;10(7):517-21. google scholar
• 7. Orfanos CE. Treatment of psoriasis with retinoids: present status. Cutis 1999;64(5):347-53. google scholar
• 8. Kullavanijaya P, Kulthanan K. Clinical efficacy and side effects of acitretin on the disorders of keratinization: a one-year study. J Dermatol 1993;20(8):501-6. google scholar
• 9. Tsambaos D, Sakkis T, Chroni E, Koniavitou K, Monastirli A, Pasmatzi E, et al. Peripheral sensory neuropathy associated with shortterm oral acitretin therapy. Skin Pharmacol Appl Skin Physiol 2003;16(1):46-9. google scholar 10. Chroni E, Monastirli A, Pasmatzi E, Sakkis T, Georgiou S, Paschalis C, et al. Sensorimotor polyneuropathy after a three-month oral acitretin therapy. Clin Neuropharmacol 2002;25(6):310-2. google scholar
• 11. Mahasitthiwat V. A woman with sudden bilateral sensorineural hearing loss after treatment psoriasis with acitretin. J Med Assoc Thai 2005;88(Suppl 1):S79-81. google scholar
• 12. Boer J, Nazary M. Long-term results of acitretin therapy for hidradenitis suppurativa. Is acne inversa also a misnomer? Br J Dermatol 2011;164(1):170-5. google scholar
• 13. Karaosmanoglu N, Akko; A, Akkoca 0, Ekjioglu HM. The effects of oral retinoids on hearing status: A prospective clinical study. J Med Sci 2019;39:245-50. google scholar
• 14. Durrant J, Campbell K, Fausti S. American Academy of Audiology Position Statement and Practical Guidelines, Ototoxicity monitoring. J Am Acad of Aud 2009;1-25. URL: audiology-web.s3.amazonaws.com/migrated/OtoMonGuidelines. pdf_539974c40999c1.58842217.pdf google scholar 15. American National Standards Institute. (2004a). Methods for manual pure-tone threshold audiometry (ANSI S3.21-2004). New York https://webstore.ansi.org/standards/asa/ ansiasas3212004r2009 google scholar
• 16. American Speech-Language-Hearing Association. Guidelines for the audiologic management of individuals receiving cochleotoxic drug therapy. ASHA 1994;36:11-19. https://www.asha.org/policy/ gl1994-00003/ google scholar
• 17. Theunissen EA, Dreschler WA, Latenstein MN, Rasch CR, van der Baan S, de Boer JP, et al. A new grading system for ototoxicity in adults. Ann Otol Rhinol Laryngol 2014;123(10):711-8. google scholar
• 18. Clark JG. Uses and abuses of hearing loss classification. ASHA 1981;23:493-500. google scholar
• 19. Lord SG. Monitoring Protocols for Cochlear Toxicity. Semin Hear 2019;40(2):122-43. google scholar
• 20. Crundwell G, Gomersall P, Baguley DM. Ototoxicity (cochleotoxicity) classifications: A review. Int J Audiol 2016;55(2):65-74. google scholar
• 21. Heath MS, Sahni DR, Curry ZA, Feldman SR. Pharmacokinetics of tazarotene and acitretin in psoriasis. Expert Opin Drug Metab Toxicol 2018;14:919-27. google scholar
• 22. Akdağ M, Akkurt ZM, Özkurt FE. Irreversible hearing loss due to the use of oral isotretinoin. J Basic Appl Sci Res 2013;3:288-91. google scholar
• 23. Rosende L, Verea-Hernando MM, de Andrés A, Pineyro-Molina F, Barja J, Castro-Castro S, et al. Hypoacusia in a patient treated by isotretinoin. Case Rep Med 2011;2011:789143. doi: 10.1155/2011/789143. google scholar
• 24. Akdag M, Akkurt ZM, Gul A, Ucmak D, Yılmaz B, Sengul E, et al. The effects of oral isotretinoin (13-Cis retinoic acid) on the inner ear: a prospective clinical study. Clin Invest Med 2014;37(2):E102-7. google scholar
• 25. Ugur KS, Erpolat S, Kurtaran H, Ark N, Sarifakioglu E, Gunduz M. The effects of oral isotretinoin (13-Cis Retinoic Acid) on the inner ear: A clinical study. Int Adv Otol 2012;8(3):339-44. google scholar
• 26. Karabulut H, Karadag AS, Acar B, Dagli M, Karabulut I, Ozmen E, et al. The effect of oral isotretinoin (13-cis retinoic acid) on hearing systems in patients with acne vulgaris: a prospective study. Int J Dermatol 2011;50(9):1139-43. google scholar
• 27. Lefebvre PP, Malgrange B, Staecker H, Moonen G, Van de Water TR. Retinoic acid stimulates regeneration of mammalian auditory hair cells. Science 1993;260(5108):692-5. google scholar
• 28. Alan MA, Eryılmaz MA, Kaymaz F, Suzer A, Arıcıgil M. Isotretinoin’s action against cisplatin-induced ototoxicity in rats. Pak J Pharm Sci 2018;31(6 (Supplementary):2579-84. google scholar
• 29. Sun YS, Fang WH, Kao TW, Yang HF, Peng TC, Wu LW, et al. Components of Metabolic Syndrome as Risk Factors for Hearing Threshold Shifts. PLoS One 2015;10(8):e0134388. doi: 10.1371/ journal.pone.0134388. google scholar
• 30. Vir D, Sharma P, Mahajan R, Dogra S, Bakshi J, Panda NK. Investigation of high-frequency hearing loss and outer hair cell function of the cochlea in patients with psoriasis: a case-control study. Clin Exp Dermatol 2019;44(5):520-3. google scholar
• 31. Yen YC, Lin YS, Weng SF, Lai FJ. Risk of sudden sensorineural hearing loss in patients with psoriasis: a retrospective cohort study. Am J Clin Dermatol 2015;16(3):213-20. google scholar
• 32. Borgia F, Ciodaro F, Guarneri F, Bartolotta A, Papaianni V, Guarneri C, et al. Auditory System Involvement in Psoriasis. Acta Derm Venereol 2018;98(7):655-9. google scholar
• 33. Karabulut H, Karadag AS, Dagli M, Acar B, Babademez M, Şahin Y, et al. Investigation of hearing and outer hair cell function of cochlea in patients with psoriasis. J Int Adv Otol 2010;6(2):239-44. google scholar
• 34. Ertugrul G, Ertugrul S, Soylemez E. Evaluation of audiovestibular system in psoriasis patients without joint involvement. Dermatol Ther 2020;33(3):e13396. doi: 10.1111/dth.13396. google scholar