Acitretin (Soriatane®)

Acitretin (Soriatane®) is a retinoid with properties similar to vitamin A. For most patients, it does not appear to be as effective as methotrexate or cyclosporine in the treatment of plaque psoriasis. However, it works quite well for pustular psoriasis. Acitretin is prescribed mainly for men and also for women who are post-menopausal or have had a hysterectomy. It is not used in women of child bearing age because of the risks of birth defects. Monitoring by your doctor and regular blood tests are required while taking this medication.

How the treatment works

The exact mechanism of action is unknown, however, it is believed to inhibit cell replication by controlling cellular differentiation within the epidermis (outmost layer of skin). It reduces inflammation and influences the growth rate of skin cells.

Advantages/Benefits

Convenient dosing - usually taken once daily in pill form.
It is most effective as part of a combination treatment with UVB and PUVA.
It is most effective for treating pustular (including palmoplantar psoriasis) or erythrodermic forms of psoriasis.
Acitretin usually does not cause organ damage, as is the case with other medicines (such as methotrexate and cyclosporine), therefore, it can be used for long-term maintenance therapy.
Unlike other systemic therapies for psoriasis, it does not suppress the immune system.

Disadvantages/Risks

It works slowly and the onset of response is usually 2-4 months.
It is not as effective when used alone, but can be combined with phototherapy, as well as the biologic agents.
Side-effects include dryness and irritation of the skin, lips, eyes, nose, and mucous membrane surfaces.
Other adverse side-effects include elevation of the cholesterol and triglyceride levels, liver toxicity and bone changes.
It can cause birth defects. Acceptable method(s) of birth control must be practiced and discussed with your doctor. Because of the long time it takes for the body to eliminate this medicine, even after treatment is stopped, women must continue to avoid pregnancy for the next 3 years.
Safety concerns include hyperlipidemia [high lipids (fats) in the bloodstream, which can promote hardening of the arteries] and alopecia (hair loss).
Blood tests must be performed just prior to starting therapy and 2-4 weeks thereafter while undergoing treatment.
Depression and psychiatric symptoms, such as aggressive behavior and thoughts of suicide, have been reported by patients using some oral retinoids, but a direct link has not been established.

Comments & Suggestions

The main issue with compliance is to minimize side-effects through inclusion of topical agents and phototherapy.
Due to the medication's drying effects, frequent regular use of a moisturizer is essential to help reduce the irritation.
Starting with a lower dose may ease the intensity of side-effects.