However, at the 50 mg/d dosage, acitretin exhibits a relatively high rate of adverse events, a finding in the original pivotal trials as well as in subsequent clinical practice5 (also D.J.P.; Kristen B. Higgins, MD; Katherine Stealey, MD; Rajesh Balkrishman, PhD; Martha Crane, PhD; Fabian Camacho, MD; Alan Fleischer, MD; S.R.F.; unpublished data, 2006). Most are minor and include dry skin and mucous membranes, pruritus, alopecia, rhinitis, epistaxis, nail disorder, and swollen or bleeding gums. Gastric symptoms also have been reported and include stomach pain, diarrhea, and vomiting. Nonspecific headaches, hot flashes, and flushing also may occur. Other serious but rare adverse effects include blurred vision, eye pain, photosensitivity, swelling of extremities, depression, suicidal ideation, bone and muscle pain, numbness and tingling in hands or feet, chest pain, confusion, arrhythmias, dizziness, and shortness of breath. As a systemic retinoid, acitretin is metabolized by the liver and has the potential to perturb hepatic function. Another known adverse effect of acitretin in some individuals is the potential to elevate serum triglycerides (TGs) to significant levels; routine monitoring is advised4,5 (also K.K.Z., E.J.M., D.J.P., R.R., and S.R.F., unpublished data, 2005). Despite this adverse effect profile, acitretin features prominently in many monotherapy and combination regimens.