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Acitretin is one of a group of drugs known as retinoids, which are related to vitamin A. Retinoids have been used to treat psoriasis since 1975, however acitretin is the only one usually selected for treating psoriasis.
Who is acitretin for?
Acitretin is for people with severe psoriasis who have not had a good response from, or are unsuitable for, topical treatments (treatments that are applied to the skin) or phototherapy. Acitretin is also used to treat severe pustular psoriasis on the palms of the hands and soles of the feet (also known as palmoplantar pustulosis, or PPP).
How does acitretin work?
The precise mechanism of how acitretin works is not fully understood, but it is thought to slow the skin cell reproduction process, which is faster in people with psoriasis than in those without. Unlike other traditional systemic treatments used for psoriasis (such as methotrexate or ciclosporin), acitretin does not suppress the immune system.
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?
- Women of childbearing age are not advised to take acitretin. Retinoids can cause birth defects and so both pregnancy and breastfeeding must be avoided whilst on acitretin and for two years after the therapy has stopped. Effective contraception must be used during this time.
- People taking other vitamin A-based medications (sometimes referred to as ‘retinoids’), methotrexate, progesterone-only contraceptive pills (sometimes referred to as ‘minipills’), keratolytics (such as salicylic acid) and certain types of antibiotics should not take acitretin.
- Acitretin should be used with caution in those with kidney or liver problems, or high cholesterol. If these problems are severe, acitretin will not be suitable. Your Dermatologist should discuss this with you, if relevant.
Women and men on acitretin should not donate blood 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.
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 mouth, nose and eyelids; burning sensation or itching on the skin; hair loss; bleeding gums; conjunctivitis (eye inflammation); blurred vision; thirst; nausea and vomiting; headache; muscle pain and feeling cold.
Acitretin makes those taking it more sensitive to the effects of UV light, including the sun. Therefore, it is sensible to reduce exposure to UV light (including sunlight and sunbeds) and to use suncream 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.
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.