What is acitretin?
Acitretin is an oral retinoid (derived from vitamin A) that has effects on growth of skin cells and is anti-inflammatory. Acitretin reduces excessive skin cell growth that is a feature of conditions such as psoriasis. It hence, reduces the scale and thickness of the psoriatic lesions.
Acitretin is best taken with food, as this increases the absorption of the drug.
What is it used for?
Other uses for acitretin include:
- Palmoplantar keratodermas
- Pityriasis rubra pilaris
- Lichen planus
- Palmoplantar pustulosis
- Dariers disease
- Hailey-Hailey disease
- Cutaneous lupus erythematosus
- Cutaneous T-cell lymphomas (Bexarotene)
- Confluent and reticulated papillomatosis
- Subcorneal pustular dermatosis
- Hidradenitis suppuritiva
- Dissecting folliculitis of the scalp
- Acne keloidalis nuchae
- Cutaneous warts (extensive)
- Granuloma annulare
- Actinic keratoses or squamous cell carcinomas (extensive).
What precautions should you take with acitretin?
- Acitretin causes severe birth defects or miscarriage. Under no circumstances should you fall pregnant on this drug. Two forms of reliable contraception methods should be used at least 1 month before treatment is started, during treatment and for 3 years after stopping the treatment. If you think you may be pregnant, stop taking the drug immediately and contact your dermatologist.
(Note: Acitretin does NOT affect male sperm or fertility)
- Do not give your medication to anyone else.
- Avoid excessive alcohol intake when taking this drug.
- Do not breastfeed while taking this medication.
- Avoid sunlight (UV radiation) during treatment. Always use a broad-spectrum sunscreen (SPF50+) on exposed skin.
- Avoid using this medication if you are taking tetracycline-based antibiotics (doxycycline, minocycline,) methotrexate, phenytoin or any other form of vitamin A.
- Tell your dermatologist if you are diabetic or drink excessive levels of alcohol.
- Avoid taking or using any other form of vitamin A (vitamin tablets, creams etc).
- You cannot donate blood whilst on this treatment and for 3 years after stopping treatment (because if your blood is given to a pregnant woman, it can cause birth defects).
- It is best avoided in children less than 10 years old as it can stunt bone growth.
What monitoring is required?
In general a blood test is required before and during treatment with Acitretin. This is to check your liver function and your cholesterol level (triglycerides). In females, a pregnancy test is also undertaken before and during treatment.
What to expect when using acitretin and potential side effects
- Acitretin commonly causes dry, cracked lips and skin. A lip balm and moisturiser is recommended during treatment. Peeling and redness of the skin is common.
- Acitretin may cause dry eyes. The use of eye drops or lubricants will alleviate some discomfort you may be experiencing. If wearing contact lenses becomes uncomfortable, it is recommended that you wear glasses for the duration of the treatment.
- Acitretin may affect the liver, increase the level of triglycerides (fat) in the blood and may affect blood sugar levels in diabetics. Regular blood monitoring is required.
- Acitretin will make your skin more sensitive to sunlight and sunburn. Protect your skin from the sun whilst taking this medication.
- Acitretin can delay wound healing. Take extra care when having any non-urgent or cosmetic treatment done especially on the face, e.g. waxing, laser therapy, dermabrasion and any non-urgent surgery.
- Other possible side effects include:
- Blurred vision and/or decreased night vision
- Muscle aches and joint pains or stiffness
- Hair loss – usually temporary and reversible when the medication is stopped
- Headaches. It is important to tell your dermatologist immediately if you experience headaches that are unusually severe, persistent and/ or associated with nausea and vomiting as it could be the result of increased pressure in the brain
- Nail changes including paronychia
- Dry nose and nose bleeds
- Nausea, vomiting, abdominal pain and heartburn.
For a full list of known side effects, please refer to the product information leaflet provided with the medication.
Tell your dermatologist if you experience any of the side effects mentioned above. In most cases, these symptoms will subside when treatment is stopped. Before taking this medication, please ensure you have read and understood the product information provided with the medication.
This information has been written by Dr Eleni Yiasemides
Updated January 2020