Acitretin for Psoriasis: Is It the Right Treatment for You?

Living with a chronic skin condition like psoriasis can significantly impact your quality of life. While topical treatments may provide relief, oral medications like Acitretin can be a valuable option for managing more severe cases.

Acitretin is a prescription retinoid, a class of medication that works by targeting the underlying causes of certain skin disorders. It promotes healthier skin growth and reduces inflammation, leading to clearer skin.

If you've recently been prescribed Acitretin or are considering it as a treatment option, understanding how it works and its potential benefits can help you make informed decisions about your skin health.

• Drug class: Retinoid
  Retinoids are derivatives of vitamin A and work by regulating skin cell production and growth. This class of drugs is particularly effective in managing skin conditions that involve abnormal or excessive skin cell regeneration cycles, as seen with psoriasis.
• Brands: Soriatane
• Form: Oral capsule
• Strengths:
  • 10 mg
  • 17.5 mg
  • 25 mg

How It Works

Acitretin belongs to a class of medications called retinoids, which are related to vitamin A. These medications help manage skin conditions by influencing how skin cells develop. By slowing down the overproduction of these cells, Acitretin allows the skin to heal more normally. This, in turn, reduces the thick, scaly patches associated with psoriasis.

In essence, Acitretin helps normalize the skin's growth process, leading to clearer skin by calming down the rapid cell turnover characteristic of psoriasis.

Course of Treatment

It may take around 2 to 3 months to fully notice the benefits of acitretin. It is important to understand that your skin might appear worse before showing signs of improvement, as Acitretin can lead to side effects, including peeling and dryness.

Typically, a 2 to 3-month period is needed to assess whether this medication is working. If it has shown to be effective for you, your dermatologist may recommend continuing treatment to manage your psoriasis. Your doctor will inform you of the duration you should remain on this medication.

Keep in mind that for those on long-term Acitretin, regular check-ups are important to monitor for any potential long-term side effects.

Application Instructions

Acitretin is typically taken once daily by mouth with a meal. To maintain consistent levels in your body, it's important to take your dose at the same time each day. Your doctor may start you on a low dose and gradually increase it over time.

Always speak with your dermatologist before making any changes to your Acitretin dosage. If you're considering stopping this medication, discuss it with your healthcare provider first.

Keep in mind that it is possible that your symptoms could return once you stop using this medication. If this occurs, inform your doctor.

Who Should Avoid Using Acitretin?

Acitretin is generally prescribed for patients who have severe psoriasis that has not found improvement with other treatments. However, not everyone can use this medication. Those who should avoid using Acitretin include the following:

• Women who are pregnant or planning on becoming pregnant. Women who are of childbearing age can use Acitretin, but they must avoid getting pregnant while on the medication and for at least 3 years after stopping it, as Acitretin can cause serious birth defects.
• Patients with liver or kidney problems: Acitretin is processed by the liver, so it is important for patients with healthy liver function to use this medication.
• Patients who consume alcohol frequently: Alcohol can affect how Acitretin works and can cause it to stay in the body longer, which increases the risk of side effects.

Side Effects

As with any medication, Acitretin may cause side effects, some common and some more serious. It is important to monitor how your body reacts and speak with your doctor if you notice any concerning symptoms.

Common Side Effects

As fluorouracil works to eliminate abnormal skin cells, it's common to experience some side effects at the application site. These typically include:

• Dry Skin and Mucous Membranes: Dry, itchy, or scaly skin, as well as dry mouth and lips, are common.
• Eye Irritation: Dry or itchy eyes may require lubricating eye drops.
• Nosebleeds: Dry nasal passages can lead to nosebleeds.
• Hair Changes: Thinning hair or hair loss may occur.
• Sun Sensitivity: Increased sensitivity to sunlight may cause sunburn. It's essential to use sunscreen and protective clothing.
• Joint Pain: Joint pain and back pain may develop.
• Neurological Symptoms: Nerve pain or tingling, fatigue, appetite changes, and vision changes may occur.

Serious Side Effects (Rare)

• Mental Health Changes: Mood changes, including depression or suicidal thoughts, can occur. If you experience feelings of sadness, hopelessness, anxiety, irritability, or thoughts of self-harm, seek immediate medical attention.
• Vision Changes: Acitretin can affect vision, leading to blurred vision, sensitivity to light, night vision problems, or even sudden vision loss. Contact your healthcare provider immediately if you notice any changes in your vision.
• Liver Problems: Liver damage can occur, leading to serious health issues. Symptoms include jaundice (yellowing of the skin or eyes), dark urine, severe tiredness, nausea, vomiting, or pain in the upper right abdomen. Stop the medication and seek immediate medical attention. Regular liver function tests are often needed to monitor for this.
• Allergic Reactions: Severe allergic reactions can occur, characterized by rash, itching, hives, swelling, especially of the face, lips, tongue, or throat, and difficulty breathing. This is a medical emergency, so seek immediate medical help.
• Capillary Leak Syndrome: This rare condition causes fluid leakage from blood vessels, leading to swelling, low blood pressure, and dizziness. Immediate medical attention is necessary as it can lead to organ failure or shock.
• Cardiovascular Risks: Acitretin can increase the risk of heart attacks, strokes, and blood clots. Symptoms of a heart attack include chest pain, shortness of breath, and arm or shoulder pain. Symptoms of a stroke include sudden weakness, difficulty speaking, confusion, and vision problems. Symptoms of a blood clot include swelling, redness, and pain in the legs. Seek immediate emergency medical attention if you experience these symptoms.
• High Blood Sugar: Acitretin can elevate blood sugar levels, especially in people with diabetes. Symptoms include increased thirst, frequent urination, confusion, fatigue, or fruity-smelling breath. Contact your doctor immediately, especially if you have diabetes.

Important Warnings

Acitretin comes with several important warnings that patients should be aware of before starting treatment. These warnings highlight the serious risks associated with this medication, including a black box warning issued by the FDA, which is the strictest type of warning used to inform patients and healthcare providers of significant dangers.

• Birth Defects: Acitretin poses a significant risk of severe birth defects. Women who are pregnant or may become pregnant must not take Acitretin. If you are capable of becoming pregnant, you'll need to use two reliable forms of birth control and take monthly pregnancy tests throughout treatment and for three years after stopping.
• Breastfeeding: Breastfeeding is not recommended while taking Acitretin, as this drug can pass into breast milk and harm a nursing infant.
• Male Fertility: Men taking Acitretin should be aware of the potential risk of birth defects if their partner becomes pregnant.
• Blood Donation: Avoid donating blood while taking Acitretin and for three years after stopping. This is because if the blood were to be given to a pregnant woman or someone planning to have children, it could cause serious harm to the unborn baby due to the presence of Acitretin in the bloodstream.
• Alcohol Avoidance: Avoid alcohol entirely during treatment and for two months after stopping. Alcohol interacts with Acitretin and causes it to stay in your body for longer periods, increasing the likelihood of severe side effects. Additionally, alcohol can worsen any liver problems associated with Acitretin use, making it even more dangerous to consume.
• Sun Sensitivity: Protect your skin from the sun by using sunscreen and protective clothing.

Acitretin Drug Interactions

Acitretin can interact with certain medications, affecting how well they work or increasing your risk of side effects. To ensure safe and effective use of Acitretin, it's crucial to discuss all medications you take with your doctor.

• Tetracyclines (antibiotics): Combining Acitretin with tetracyclines (like Doxycycline or Minocycline) can raise the risk of pseudotumor cerebri. This condition causes increased pressure in your skull, leading to headaches, nausea, and vision problems. This combination should be avoided.
• Methotrexate: Both Acitretin and methotrexate are broken down by the liver. Taking them together significantly increases the risk of liver damage. Your doctor will likely avoid this combination or closely monitor your liver function if both medications are deemed necessary.
• Vitamin A supplements: Acitretin is a retinoid, a type of vitamin A. Taking additional vitamin A supplements while on Acitretin can lead to hypervitaminosis A. This condition occurs when you have too much vitamin A in your body, causing symptoms like dry skin, dizziness, and liver damage. Steer clear of vitamin A supplements during Acitretin treatment.

Speak with Your Doctor

Because Acitretin carries significant risks, it is important to maintain open communication with your doctor throughout your treatment.

Your doctor will monitor your health closely and help you manage any side effects or concerns that come up. Always reach out if you experience serious side effects or if you are unsure about any part of your treatment plan.