Treatments

Acitretin

Your dermatologist has discussed acitretin with you. This leaflet provides information about this medicine. If you still have questions after reading it, you can always discuss them with your dermatologist.

Please note: this leaflet is not a replacement for the package leaflet. Always read the package leaflet before starting the medicine so that you are well informed about its effects, side effects, and interactions with your other medication.

What is acitretin?

Acitretin is a medicine that is mainly used for skin conditions in which the normal maturation of the skin is disrupted. Because skin cells do not mature properly, scaling and thickening of the skin can occur. The medicine is mainly used for severe or persistent psoriasis (see also the psoriasis leaflet). The aim of treatment with acitretin is to calm the skin condition and bring it under control.

How does acitretin work?

The active substance acitretin belongs to the group of retinoids and is derived from vitamin A. Acitretin normalizes cell division, maturation, and keratinization of the skin.

How well does acitretin work?

After about two to four weeks, scaling and thickening of the skin usually decrease and the skin begins to recover. However, it takes approximately 6–8 weeks to reach the optimal effect, and this can take up to 3 months. Although side effects have been described for this medicine, there is extensive experience with it in dermatology. The large majority of patients tolerate this medicine well and experience a good effect on the skin.

When does your dermatologist prescribe acitretin?

This medicine is mainly used for severe or persistent psoriasis, but it can also be prescribed for conditions such as ichthyosis (“fish scale disease”), lichen planus, and excessive keratinization of the palms and soles (palmoplantar hyperkeratosis).

When should you NOT use acitretin?

• If you are pregnant or trying to become pregnant. Acitretin can cause severe birth defects. It is only safe to become pregnant 3 years after stopping treatment with acitretin. For this reason, it is rarely prescribed to young women of childbearing age. The medicine does not affect fertility in women or men.
• If you are breastfeeding.
• If you have liver disease or severe kidney disease.
• If you have very high fat levels in your blood (high cholesterol or triglycerides).
• If you have too much vitamin A in your body (hypervitaminosis A).
• If you consume excessive alcohol.

Acitretin is prescribed to women who could become pregnant (childbearing age) only under very strict conditions. Effective contraception must be ensured during treatment and for up to 3 years after stopping treatment. The dermatologist may refer you to your GP or a specialist for advice about contraception.

Your doctor will ask you to sign a form stating that you are aware of the risks and that you agree to the necessary measures (such as regular pregnancy tests).

Men: Very small amounts of acitretin can be found in the semen of men taking acitretin, but this is too little to cause harm to your partner’s unborn child. Never give your medication to others.

Children: The use of acitretin in children is only applied in rare cases.

What are the possible side effects of acitretin?

You may experience side effects while taking acitretin. Not everyone gets side effects. The chance of side effects depends on your own sensitivity and the prescribed dose of acitretin.

Most common possible side effects:

• Dry lips, dry sensitive skin, and rash
• Dry nasal mucosa, which can cause nosebleeds
• Dry eyes, which may cause blurred vision or eye inflammation
• Increased liver enzymes and increased blood fat levels
• More fragile nails
• Hair loss

Rare possible side effects:

• Depressive symptoms may possibly increase in rare cases. People with a history of depression should be alert to this.

A number of other side effects have also been reported. For a complete overview of possible side effects, it is important to read the package leaflet carefully before starting acitretin.

If you think you are experiencing side effects, contact your dermatologist.

Why do you need blood and/or urine tests while using acitretin?

Blood values, liver function tests, and blood fat levels are checked regularly. These values can increase due to acitretin. In women of childbearing age, regular pregnancy tests are also performed.

When should you warn your doctor?

• If you become pregnant while taking acitretin, you must stop taking the medicine immediately and consult your doctor. Also contact your doctor if you become pregnant in the three years after stopping treatment.
• Severe depressive feelings and/or suicidal thoughts
• Yellowing of the skin or eyes and feeling tired. These may be signs of liver problems (hepatitis).
• Other serious side effects

Can acitretin be used together with other medicines?

Acitretin must never be used together with tetracyclines (antibiotics such as doxycycline or minocycline) because this can increase pressure in the brain. There are also a number of other medicines that are better not taken together with acitretin. It is very important that your doctor is aware of all medicines you use. It is therefore wise to always bring a list of your medications (medication overview) when you go to the hospital.

Even if you are already using acitretin, it is important that your prescribing doctor is aware of all your medicines. The doctor will check whether the medicines can be used together.

Always collect your medication from your regular pharmacy. Your own pharmacy has a good overview and can check whether all prescribed medicines can be used together.

How many capsules should you take and how long does treatment last?

Acitretin capsules are available in 10 mg and 25 mg. Take the capsules during a meal. Usually, you start with a low dose, which is gradually increased. This depends on how your skin condition develops and/or on side effects. Once your skin condition has (almost) disappeared, you can stop treatment or switch to maintenance treatment. Treatment can last from several months to many years.

What can you do yourself / what should you avoid?

• Women must absolutely ensure effective contraception.
• Use a greasy ointment for the lips during treatment.
• Do not use irritating products on the skin. This can make the skin even drier and cause symptoms such as itching and redness.
• Avoid exposure to sunlight and do not use sunbeds/tanning beds. Before going into the sun, use sunscreen with a high protection factor (at least SPF 30).
• Reduce intensive sports or extreme physical activity if needed. Acitretin can cause muscle and joint pain.
• Do not take vitamin A supplements during treatment. Using them together can increase the risk of side effects.
• Do not donate blood during treatment with acitretin or for 3 years after stopping treatment. If your blood is given to someone who is pregnant, the baby could be born with abnormalities.
• Do not drink alcohol (or drink very little) during treatment.