What is Acitretin: Uses, Dosage, Side Effects and More

Acitretin is a powerful oral medication that belongs to a class of drugs called retinoids, which are closely related to vitamin A. Your doctor might prescribe this medication if you're dealing with severe psoriasis that hasn't responded well to other treatments.

This medication works by slowing down the rapid growth of skin cells that causes the thick, scaly patches characteristic of psoriasis. While it can be highly effective, acitretin requires careful monitoring due to its strength and potential side effects.

What is Acitretin?

Acitretin is a synthetic retinoid that mimics the effects of vitamin A in your body. It's specifically designed to treat severe skin conditions by regulating how your skin cells grow and shed.

This medication is considered a systemic treatment, meaning it works throughout your entire body rather than just on the surface of your skin. Unlike topical treatments you apply directly to affected areas, acitretin travels through your bloodstream to reach skin cells everywhere.

The drug is particularly valuable for people with psoriasis because it addresses the underlying cellular processes that cause this chronic condition. It essentially helps normalize the way your skin produces and replaces cells.

What is Acitretin Used For?

Acitretin is primarily prescribed for severe psoriasis, especially when other treatments haven't provided sufficient relief. Your doctor will typically consider this medication when topical treatments and light therapy haven't been effective enough.

The medication works particularly well for certain types of psoriasis that can be especially challenging to treat. Here are the main conditions where acitretin shows the most benefit:

• Severe plaque psoriasis covering large areas of your body
• Pustular psoriasis, which causes pus-filled bumps on your skin
• Erythrodermic psoriasis, a rare but serious form that affects most of your body
• Psoriasis affecting your palms and soles, which can be particularly stubborn

In some cases, doctors may also prescribe acitretin for other severe skin conditions like certain types of ichthyosis or keratosis disorders. However, psoriasis remains its most common and well-studied use.

How Does Acitretin Work?

Acitretin works by binding to specific receptors in your skin cells and regulating gene expression. This process helps normalize the rapid cell turnover that characterizes psoriasis.

In healthy skin, cells take about 28 days to move from the deeper layers to the surface where they naturally shed. With psoriasis, this process speeds up dramatically to just 3-4 days, creating the thick, scaly patches you see.

Acitretin essentially tells your skin cells to slow down and behave more normally. It reduces inflammation and helps prevent the excessive buildup of skin cells that forms psoriatic plaques.

This medication is considered quite potent in the world of psoriasis treatments. While it's not the strongest option available, it's significantly more powerful than topical treatments and can produce substantial improvements in severe cases.

How Should I Take Acitretin?

Always take acitretin exactly as your doctor prescribes, typically once daily with your main meal. Taking it with food, especially something containing some fat, helps your body absorb the medication more effectively.

You'll want to swallow the capsules whole with a full glass of water. Don't crush, chew, or open the capsules, as this can affect how the medication works and may cause irritation to your mouth or throat.

Here are some important guidelines to follow when taking acitretin:

• Take it at the same time each day to maintain steady levels in your body
• Have it with your largest meal of the day for better absorption
• Avoid taking it with milk or dairy products, as these can reduce absorption
• Don't take vitamin A supplements while on this medication

Your doctor will likely start you on a lower dose and gradually adjust it based on how you respond and any side effects you experience. This careful approach helps minimize potential problems while maximizing benefits.

How Long Should I Take Acitretin For?

The length of acitretin treatment varies significantly from person to person, but most people need to take it for several months to see full benefits. Your doctor will typically recommend staying on the medication for at least 3-4 months to properly evaluate its effectiveness.

Many people continue taking acitretin for 6-12 months or longer, depending on their response and tolerance. Some individuals with severe psoriasis may need long-term treatment to maintain clear skin.

Your doctor will regularly monitor your progress and may adjust your treatment plan based on several factors. These include how well your skin is responding, any side effects you're experiencing, and your overall health status.

It's crucial never to stop taking acitretin suddenly without discussing it with your doctor first. Your psoriasis symptoms may return, and in some cases, they can come back worse than before if the medication is discontinued abruptly.

What Are the Side Effects of Acitretin?

Like all powerful medications, acitretin can cause side effects, though not everyone experiences them. The most common side effects are related to the medication's vitamin A-like effects on your body.

Understanding what to expect can help you feel more prepared and know when to contact your doctor. Here are the most frequently reported side effects:

• Dry skin and lips, which affects most people taking this medication
• Hair thinning or temporary hair loss
• Dry eyes and potential vision changes
• Peeling skin on your palms and soles
• Increased sensitivity to sunlight
• Nosebleeds due to dry nasal passages
• Joint or muscle aches
• Headaches

While these common side effects can be uncomfortable, they're usually manageable with proper care and often improve as your body adjusts to the medication.

More serious side effects are less common but require immediate medical attention. These can include severe mood changes, signs of liver problems like yellowing of your skin or eyes, or persistent severe headaches.

Some people may experience rare but significant side effects that need prompt medical evaluation. These include severe depression, thoughts of self-harm, or signs of increased pressure in your skull like persistent headaches with vision changes.

Who Should Not Take Acitretin?

Acitretin is not suitable for everyone, and there are several important situations where this medication should be avoided entirely. Your doctor will carefully review your medical history before prescribing it.

The most critical contraindication involves pregnancy and the potential for pregnancy. Acitretin can cause severe birth defects and must never be taken by pregnant women or those who might become pregnant.

Here are the main groups of people who should not take acitretin:

• Women who are pregnant or planning to become pregnant
• Women who might become pregnant and cannot commit to reliable contraception
• People with severe liver disease or liver function problems
• Individuals with severely high cholesterol or triglyceride levels
• Those with severe kidney disease
• People taking certain medications that interact dangerously with acitretin

Your doctor will also exercise caution if you have diabetes, heart disease, or a history of depression. These conditions don't necessarily prevent you from taking acitretin, but they require closer monitoring.

If you're breastfeeding, you'll need to discuss the risks and benefits carefully with your doctor, as acitretin can pass into breast milk.

Acitretin Brand Names

Acitretin is available under several brand names, with Soriatane being the most commonly recognized in the United States. This brand name version contains the same active ingredient as generic acitretin.

Other brand names you might encounter include Neotigason in some countries, though availability varies by region. Your pharmacy may dispense either the brand name or generic version depending on your insurance coverage and availability.

Whether you receive brand name or generic acitretin, the medication works the same way. Generic versions undergo strict testing to ensure they're equivalent to the brand name product in terms of effectiveness and safety.

Acitretin Alternatives

If acitretin isn't suitable for you or doesn't provide adequate results, several alternative treatments are available for severe psoriasis. Your doctor can help you explore these options based on your specific situation.

Other systemic treatments that might be considered include methotrexate, cyclosporine, or newer biologic medications. Each has its own benefits and potential side effects to consider.

Here are some alternatives your doctor might discuss:

• Methotrexate, which suppresses your immune system to reduce inflammation
• Cyclosporine for short-term control of severe flares
• Biologic medications like adalimumab or ustekinumab
• Apremilast, an oral medication that works differently than acitretin
• Phototherapy treatments using UV light

The best alternative depends on many factors, including your medical history, the severity of your psoriasis, and your personal preferences. Your doctor will work with you to find the most appropriate option.

Is Acitretin Better Than Methotrexate?

Both acitretin and methotrexate are effective treatments for severe psoriasis, but they work in different ways and have different strengths. Neither is universally "better" than the other – the best choice depends on your individual circumstances.

Acitretin works by normalizing skin cell growth and doesn't suppress your immune system like methotrexate does. This means you're not at increased risk for infections, which can be an advantage for some people.

Methotrexate, on the other hand, works by reducing the inflammatory response that drives psoriasis. It often works faster than acitretin and may be more effective for psoriatic arthritis if you have joint symptoms.

Your doctor will consider several factors when choosing between these medications, including your overall health, other medical conditions, and how your psoriasis affects your daily life. Some people even use both medications together under careful medical supervision.