Psoriasis treatment: Oral retinoids

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Unhealthy cholesterol levels can develop while taking an oral retinoid. Adopting some healthy habits, such as eating a healthy diet, can reduce this risk.

Acitretin is an oral (take by swallowing) retinoid that the U.S. Food and Drug Administration (FDA) has approved to treat severe psoriasis. It comes from vitamin A.

Why do dermatologists prescribe an oral retinoid to treat psoriasis?

Acitretin can:

  • Slow rapidly growing skin cells
  • Reduce redness and swelling

It has been shown to effectively treat:

  • Guttate psoriasis
  • Plaque psoriasis
  • Pustular psoriasis on the hands and feet
  • Pustular psoriasis that causes extensive pus-filled blisters on the body
  • Erythrodermic psoriasis
  • Patients with severe psoriasis who test positive for HIV (human immunodeficiency virus)

Unlike other medicine for severe psoriasis, oral retinoids do NOT suppress the immune system. For this reason, dermatologists prescribe this medicine to HIV-positive patients who need strong psoriasis medicine.

Safety and effectiveness

Rapid and impressive results are often seen in patients who have pustular psoriasis.

If you have plaque psoriasis, acitretin tends to be less effective than other psoriasis medicines that work throughout the body, such as methotrexate or cyclosporine. Some patients, however, see good results. It often takes months to see the full effects when treating plaque psoriasis.

To improve results and lower the amount of acitretin you need, your dermatologist may include phototherapy in your psoriasis treatment plan.

Women: Is a loved one taking acitretin? If you are pregnant or could become pregnant, you should NOT:


  • Handle the medicine
  • Breathe dust from the capsules
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An oral retinoid can be very effective for treating a child who has severe psoriasis. A benefit of taking an oral retinoid is that it does NOT suppress the immune system. Suppressing the immune system makes it easier for you to get infections and diseases. 

How to use an oral retinoid to treat psoriasis

Acitretin is a pill that you take a pill once a day.

You want to take acitretin:


  • After eating your main meal of the day

AND

  • With a glass of milk or after eating some fatty food. Your body needs fat to absorb this medicine.
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Possible side effects

When you first take acitretin, you may notice that the psoriasis worsens. Continue to take the medicine. Most patients start seeing some improvement after about 2 weeks. It can take up to 12 weeks though.

The most common side effects tend to occur on the skin, hair, nails, and tissue inside the mouth, nose, or eyes. These include:

  • Lips: Red and swollen with cracks in the corners or your mouth
  • Dryness: This can affect your eyes, nasal passages, or mouth
  • Chapped or peeling skin
  • Hair loss
  • Brittle nails
  • Burning or sticky feeling on your skin

Other side effects include unhealthy cholesterol levels, small clusters of bumps appearing around your fingernails or toenails, reduced color vision, difficulty seeing at night, and pain in your muscles or joints. In rare cases, excessive growth or thickening of bone can occur. Other serious bone problems are possible.

You should NOT donate blood while taking acitretin and for 3 years after you stop taking it. If a pregnant woman receives your blood, her baby could be born with serious birth defects.

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One of the most serious side effects is the possibility of severe birth defects. For this reason, women who are pregnant or plan to become pregnant should NOT take acitretin.

To prevent birth defects, women should wait 3 years after taking acitretin before trying to become pregnant.

To reduce the risk of possible side effects, dermatologists carefully select their patients, prescribe the lowest possible dose, and monitor each patient.

To help your dermatologist decide if you can take acitretin, be sure to tell your dermatologist about all of your medical conditions and medicines — even if it seems unimportant.

What to discuss with your dermatologist

You should tell your dermatologist if you:

  • Experience any side effect
  • Do not see results after taking all of the medicine as prescribed
  • Have questions or concerns
  • Become pregnant or plan to become pregnant within 3 years

Explore the Psoriasis Resource Center



References
Hugh J, Van Voorhees A S, et al. “From the Medical Board of the National Psoriasis Foundation: The risk of cardiovascular disease in individuals with psoriasis and the potential impact of current therapies.” J Am Acad Dermatol. 2014 Jan;7091):168-77.

Lebwohl M et al. Translating Evidence into Practice: Psoriasis Guidelines. Symposium presented at: American Academy of Dermatology’s Summer Academy Meeting 2014. August 7-9, 2014; Chicago.

Menter A, Korman NJ, et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis Section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents.” J Am Acad Dermatol2009;61:451-85.


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