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Acitretin (also referred to by its commercial name Neotigason), is one of a group of drugs known as retinoids, which are related to vitamin A. Acitretin has been used to treat psoriasis that has not improved with topical treatments, or covers a large area of the body since the 1990’s. In the treatment of psoriasis, acitretin belongs to the group of medicines known as ‘systemics’. Systemics are treatments that are taken orally e.g., tablets that are swallowed.
Who is acitretin for?
Acitretin is for people with widespread psoriasis who have not had a good response from, or are unsuitable for, topical treatments or phototherapy.
How does acitretin work?
In people who have psoriasis, the usual skin cell reproduction process has been speeded up. This results in more skin cells being produced and at a faster rate than usual. Acitretin works by slowing down the skin cell reproduction process. Unlike other traditional systemic treatments used for psoriasis (such as methotrexate or ciclosporin), acitretin does not suppress the immune system.
It can take 2-4 weeks before you start to notice an improvement in your psoriasis and may take up to four months before you see the maximum benefit.
How is acitretin used?
Acitretin comes in a capsule form, and is taken orally every day. The capsules should be taken with food. Your doctor will tell you exactly how much to take, as this is determined for each individual based on several factors, including the type of psoriasis. The amount you take may be reduced after symptoms begin to improve, and treatment with acitretin is normally stopped when the psoriasis has cleared significantly.
Acitretin may be used in rotation with other systemic treatments such as ciclosporin and methotrexate. Acitretin can also be used with phototherapy, rather than just by itself. In some cases this combination can speed up the clearing of the skin, meaning that fewer phototherapy sessions are needed.
People taking acitretin will have regular blood tests every three months - usually carried out by Dermatology Nurses, or by their own GP - to monitor for possible effects of the treatment.
Children taking acitretin will need to have their growth closely monitored – this may include regular X Rays.
Who should not take acitretin?
- Acitretin is not normally given to women of childbearing age. This is because retinoids such as acitretin, can cause birth defects and so both pregnancy and breastfeeding must be avoided whilst taking acitretin and for three years after the therapy has stopped. Effective contraception must be used during this time. Your Dermatologist will discuss this with you prior to prescribing Acitretin, Men taking Acitretin can father children with no additional risk.
- Acitretin should be used with caution in those with kidney or liver problems, diabetes, or high cholesterol. If these problems are severe, acitretin will not be suitable. Your Dermatologist should discuss this with you, if relevant.
- Acitretin should not be used by people taking other vitamin A-based medications (sometimes referred to as 'retinoids'), or methotrexate, progesterone-only contraceptive pills (sometimes referred to as 'minipills'), keratolytics (which are treatments designed to soften or break down the top layer of skin, such as salicylic acid (a topical treatment used to treat skin conditions including psoriasis) and benzoyl peroxide (a topical treatment used to treat acne) and certain types of antibiotics (such as triglycerides). Remind your doctor that you are currently taking Acitretin to treat psoriasis if you are prescribed any other medication.
- Women and men on acitretin should not donate blood whilst taking acitretin or for at least three years after stopping treatment as this could expose a pregnant woman to acitretin. In most cases, alcohol should be avoided whilst taking acitretin, unless your doctor advises you otherwise. This is because alcohol lengthens the time acitretin is stored in the body and also increases the risk of some of the side effects associated with acitretin such as liver inflammation and raised blood fats.
What are the side effects of acitretin?
As with all medications, some side effects are possible when taking acitretin. It is important to remember that not every person taking a medication will get all, or even any, of the possible side effects listed. The most serious side effect of acitretin is the risk of birth defects, as previously mentioned.
Most of the common side effects of acitretin are mild, and usually disappear if treatment is stopped. Some also depend on the dose that is taken.
Common side effects include dryness of the ‘mucous membranes’ such as lips, mouth, nose and eyelids. This can often be managed with moisturisers, lip balms and artificial tears / eye drops. Other less common side effects include peeling of the skin (especially the palms of the hands and soles of the feet), rhinitis (sneezing and runny / stuff nose), sensations of burning, itchy, or sticky skin, sensitive skin, changes to the hair (including change in growth rate, hair loss, change in hair structure), change in the pigmentation of the skin and hair, weakening of the nails, bleeding gums and taste disturbances.
Side effects relating to the skin and mucous membranes occur in the first few days after starting treatment. Side effects relating to hair loss usually take a few weeks into treatment before being noticed. As mentioned above, these side effects are reversible if the dose is lowered, or you stop taking acitretin.
Further common side effects include issues relating to the eyes such as conjunctivitis and visual disturbances e.g. blurred vision and difficulty seeing at night. People who wear contact lenses may need to wear glasses instead whilst they are taking acitretin. An increase in thirst and feeling cold are also common side effects when taking acitretin.
Acitretin makes people who take it more sensitive to the effects of UV light, including the sun which means that you will get sun burn quicker than you may have done previously. Therefore, it is sensible to reduce exposure to UV light (including sunlight and sunbeds) and to use a high factor suncream (e.g. SPF 30+) and wear a hat when going outside. In people who are diabetic, acitretin can alter the way the body processes glucose, meaning that blood sugar levels should be closely monitored.
Always speak to your Dermatologist or Dermatology Specialist Nurse if you have concerns regarding side effects of treatments.
For a full list of potential side effects please speak to your Dermatologist or Pharmacist, or refer to the Patient Information Leaflet that is in the box of acitretin capsules.
If you have been prescribed acitretin for treatment of your psoriasis, you may be asked to take part in the British Association of Dermatologists Biologics Interventions Register (BADBIR). This register is to compare the safety of different treatments for psoriasis and to see how well they work.
The information on this page is also available in our acitretin information sheet.
September 2023 (Review Date: September 2026)