What is acitretin, and how does it work?
Acitretin is an oral retinoid, a medicine related to vitamin A, taken once a day as a capsule. Unlike cyclosporine or methotrexate, it does not suppress the immune system. It works by slowing skin-cell growth and reducing redness and swelling, though the exact mechanism against psoriasis is not fully understood. Because it does not affect immune function, dermatologists sometimes use it for patients who cannot take an immune-suppressing medicine, including some people who are HIV-positive. Evidence Evidence Evidence
Why this matters
- Sources cited, not yet graded
I read the AAD and National Psoriasis Foundation patient education pages. Both describe acitretin as an oral retinoid that slows skin-cell turnover without suppressing the immune system. NPF says the exact way it controls psoriasis is not known. I also checked the 2020 AAD-NPF systemic-therapy guideline, which lists acitretin among established systemic nonbiologic options for psoriasis.
Considerations
- Depends on you
Neither patient-education source explains why acitretin works faster for some people than others, and neither predicts an individual reader’s response.
Questions for your dermatologist
Is acitretin a reasonable option given my psoriasis and what I have already tried?
Saving keeps this on your device and needs JavaScript, which is off in this browser.Since I could still get pregnant, or plan to, how does that change whether acitretin is right for me?
Saving keeps this on your device and needs JavaScript, which is off in this browser.
What does it treat, and what can it not be combined with?
Acitretin treats several forms of psoriasis: plaque, guttate, pustular (including on the hands and feet), erythrodermic, and severe generalized disease. The current label states it must not be combined with methotrexate, because together they raise the risk of liver inflammation (hepatitis). It also must not be combined with tetracycline antibiotics, because both can raise pressure inside the skull. It must not be combined with vitamin A supplements or other oral retinoids either. Combining it with phototherapy is common, but the label states that phototherapy doses need to be reduced when acitretin is used. That is because acitretin makes skin more prone to burning. Evidence Evidence Evidence
Why this matters
- Sources cited, not yet graded
I read the current Soriatane label. It lists methotrexate, tetracyclines, and other retinoids or vitamin A as contraindicated combinations, and states that phototherapy doses require reduction when combined with acitretin. AAD and National Psoriasis Foundation patient education both describe the range of psoriasis types acitretin treats.
Considerations
- Depends on you
Neither source says exactly how much a phototherapy dose should be lowered when combined with acitretin, or how that decision is made for you.
Questions for your dermatologist
Would you combine acitretin with phototherapy or another treatment I am already using?
Saving keeps this on your device and needs JavaScript, which is off in this browser.I take ___. Could it interact with acitretin?
Saving keeps this on your device and needs JavaScript, which is off in this browser.
How often do you take it, and how long until you know if it is working?
Acitretin comes in 10 mg and 25 mg capsules, taken once a day with food, since your body needs fat to absorb it. The current label states that treatment usually begins in the 25 to 50 mg per day range, given as a single daily dose with the main meal. Your dermatologist then adjusts it based on your response. Patient-education sources report that improvement can begin within a few weeks, with fuller results building over the following months. Full effect for plaque psoriasis, specifically, can take up to six months. Unlike cyclosporine, no source states a fixed outer limit on how long treatment can continue; your dermatologist sets ongoing dosing based on your response. Evidence Evidence Evidence
Why this matters
- Sources cited, not yet graded
I read the capsule strengths, the once-daily with-food dosing instruction and the initial 25-50 mg/day range adjusted by response in the current Soriatane label. AAD reports improvement beginning around two weeks, continuing up to twelve weeks. National Psoriasis Foundation reports eight to sixteen weeks for visible improvement and up to six months for peak effect, especially for plaque psoriasis.
Considerations
- Depends on you
The label sets maintenance dosing by individual response rather than a fixed schedule, and does not state a maximum treatment duration. Patient-education sources do not predict your own timeline.
Questions for your dermatologist
What dose would you begin with, and how would you adjust it over time?
Saving keeps this on your device and needs JavaScript, which is off in this browser.Is there a point where you would expect to stop or reduce acitretin, given my case?
Saving keeps this on your device and needs JavaScript, which is off in this browser.
What are the side effects, and what should make you call your dermatologist?
The label carries a boxed warning, its strongest kind. Acitretin causes severe birth defects if taken during pregnancy. It must not be used by anyone who is pregnant, or who plans to become pregnant. People I have heard from ask whether drinking makes their psoriasis worse, and here alcohol matters for a different reason. Because alcohol can turn acitretin into a longer-lasting related compound, anyone who could become pregnant must avoid all alcohol during treatment. That alcohol restriction continues for two months after stopping. Pregnancy must also be avoided for three years after stopping acitretin. That requires two effective forms of birth control, plus a pregnancy test every three months during that window. The same three-year rule applies to donating blood. Very common effects, seen in more than three-quarters of trial patients, include chapped or cracked lips, dry eyes and mouth, skin peeling, hair thinning, and joint pain. Rarer but serious risks include liver inflammation, pancreatitis, a pressure buildup around the brain, and depression. Blood tests for liver function and cholesterol are required before starting. They continue every one to two weeks until your levels are stable. Evidence Evidence Evidence
Why this matters
- Sources cited, not yet graded
I read the boxed warning and the three-year post-treatment pregnancy-prevention and blood-donation restrictions in the current Soriatane label. It also states the two-month alcohol restriction and the liver-function and lipid monitoring schedule. AAD and National Psoriasis Foundation patient education both list the common mucocutaneous effects and the cholesterol changes seen with oral retinoids.
Considerations
- Depends on you
None of these sources gives an exact rate for every side effect in a psoriasis-specific trial population, beyond the mucocutaneous and joint figures the label reports. None predicts your own risk.
Questions for your dermatologist
Given my own pregnancy plans and alcohol use, is acitretin a safe choice for me?
Saving keeps this on your device and needs JavaScript, which is off in this browser.What lab result or symptom would make you lower my dose or stop treatment?
Saving keeps this on your device and needs JavaScript, which is off in this browser.
What does it cost?
I checked one pharmacy-price snapshot. It showed an average retail cash price of about $902 for 30 capsules of generic acitretin 25 mg. That price dropped to about $89 with a common discount coupon. Actual pharmacy prices, insurance coverage, and coupon eligibility vary, and this is one strength and quantity, not a full monthly estimate at every dose. Evidence
Why this matters
- Sources cited, not yet graded
The GoodRx snapshot I read records the dated cash and coupon price for a defined generic prescription.
Considerations
- Depends on you
This is one commercial price-comparison snapshot for one strength, not a survey of every pharmacy or plan. It does not include the added cost of required blood tests.
Questions for your dermatologist
Does my insurance cover acitretin, and what would monitoring visits and labs cost me?
Saving keeps this on your device and needs JavaScript, which is off in this browser.At my dose, about how many capsules would I need each month?
Saving keeps this on your device and needs JavaScript, which is off in this browser.
What do other people say about using it?
No reader has sent me a first-hand account of acitretin for psoriasis yet. Until someone does, here is what the label and the studies say about living with it. Evidence
Why this matters
- Sources cited, not yet graded
The once-daily dosing schedule and the with-food instruction. Also documented: the pregnancy-prevention rules that shape daily life on this medicine.
Considerations
- Depends on you
No one has written to me yet about what the alcohol restriction or the three-year contraception requirement feel like to live with.
Questions for your dermatologist
What have your other patients told you about staying on top of the pregnancy-prevention requirements?
Saving keeps this on your device and needs JavaScript, which is off in this browser.
What is worth tracking while you use it?
Keep a dated record of each dose and any dose change your dermatologist makes. Note every liver-function and cholesterol blood-test result, especially during the early weeks when your dermatologist checks most often. If you can become pregnant, track your monthly pregnancy tests and the exact date you stop treatment, since prevention continues for three years afterward. Add a same-conditions photo around the eight-to-sixteen-week mark, then again near six months, matching the timeline patient-education sources describe. Evidence Evidence
Why this matters
- Sources cited, not yet graded
A dated dose and monitoring record is what lets the eight-to-sixteen-week check-in the patient-education timeline describes actually answer whether the treatment is working. A photo record helps too. Together, they also let you and your dermatologist track time against the three-year pregnancy-prevention window those same sources describe.
Considerations
- Depends on you
A dose log and photo record do not replace the required liver, lipid, and pregnancy testing, and cannot by themselves catch a liver or mood-related problem.
Questions for your dermatologist
What should I track between now and my first check-in?
Saving keeps this on your device and needs JavaScript, which is off in this browser.
Applicability check
Who was studied?
These fields show what the cited evidence reports about the people and body sites behind outcome or safety claims. “Not reported” means the reviewed source omitted the field; “Pending exact source review” means SteadySkin has not made that determination yet.
The label carries a boxed warning, its strongest kind. Acitretin causes severe birth defects if taken during pregnancy. It must not be used by anyone who is pregnant, or who plans to become pregnant. People I have heard from ask whether drinking makes their psoriasis worse, and here alcohol matters for a different reason. Because alcohol can turn acitretin into a longer-lasting related compound, anyone who could become pregnant must avoid all alcohol during treatment. That alcohol restriction continues for two months after stopping. Pregnancy must also be avoided for three years after stopping acitretin. That requires two effective forms of birth control, plus a pregnancy test every three months during that window. The same three-year rule applies to donating blood. Very common effects, seen in more than three-quarters of trial patients, include chapped or cracked lips, dry eyes and mouth, skin peeling, hair thinning, and joint pain. Rarer but serious risks include liver inflammation, pancreatitis, a pressure buildup around the brain, and depression. Blood tests for liver function and cholesterol are required before starting. They continue every one to two weeks until your levels are stable.
- Age range
- Not reported
- Condition subtype
- Not reported
- Severity or extent
- Not reported
- Sample size
- Not reported
- Geography and care setting
- One source is the current US drug label for acitretin (Soriatane). Two sources are patient education (AAD, National Psoriasis Foundation), describing common reactions and the monitoring schedule in plain language. The label reports the most common reactions occurred in more than three-quarters of trial patients, but does not report a full psoriasis-specific adverse-reaction rate table.
- Skin tone or phototype
- Not reported
- Race
- Not reported
- Ethnicity
- Not reported
- Body sites
- Not reported
What that means for this page: These sources describe the boxed pregnancy warning, the alcohol and blood-donation restrictions, the monitoring schedule, and the range of common and serious reactions. None states how often a reaction happens in psoriasis care beyond the mucocutaneous and joint figures, and none judges one reader’s risk.
Evidence behind this page
Sources
Each evidence badge opens the source and its limits. The full list stays available here.
- American Academy of DermatologyGuideline · Regulatory / guideline, tier 1Relevant relationship disclosed
- Published
- SteadySkin last checked
What this source can and cannot tell you
Why the independence label says this: The guideline reports author relationships; it is not independent comparative proof for an individual choice.
What this source supports
Supports that methotrexate, apremilast, cyclosporine and acitretin are established systemic nonbiologic options considered in psoriasis care.
What it does not support
It does not select, rank or prescribe an option for an individual reader.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- American Academy of DermatologyPatient education · Patient education, tier 5Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports that acitretin is an oral retinoid, related to vitamin A, that the FDA has approved for severe psoriasis and that it does not suppress the immune system. Supports that it treats guttate, plaque, and pustular psoriasis on the hands and feet, extensive pustular psoriasis, erythrodermic psoriasis, and severe psoriasis in HIV-positive patients. Supports that it is taken once a day after the main meal, with fat-containing food or milk to help absorption. Supports that most patients start seeing some improvement after about two weeks, and that it can take up to twelve weeks. Supports common side effects including cracked and swollen lips, dry eyes and mouth, chapped skin, hair loss, brittle nails, unhealthy cholesterol levels, and vision problems. Supports that women who are pregnant or plan to become pregnant should not take acitretin. Supports that they must wait three years after stopping before trying to become pregnant, and should not donate blood during that same three-year window.
What it does not support
Does not report a psoriasis-specific clinical-trial adverse-reaction rate table, does not report an alcohol-interaction warning, and does not predict an individual reader’s dose, response, or timeline.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- National Psoriasis FoundationPatient education · Patient education, tier 5Independence not established
- Published
- SteadySkin last checked
What this source can and cannot tell you
Why the independence label says this: The organization provides patient education, but its editorial and funding independence for this page was not independently reviewed. It is used only for patient-facing treatment-category and monitoring context.
What this source supports
Supports that Soriatane (acitretin) is FDA-approved for severe plaque, guttate, pustular, erythrodermic, or palmoplantar psoriasis in adults, and that the exact way it controls psoriasis is not known. Supports that it comes in 10 mg and 25 mg capsules taken once daily with food, with the dose adjusted by individual response. Supports that skin improvement usually appears after eight to sixteen weeks, and that peak effect can take up to six months, especially for plaque psoriasis. Supports that it is often combined with phototherapy, and sometimes with biologics or used in rotation with cyclosporine or methotrexate. Supports the pregnancy contraindication and the requirement for two negative pregnancy tests and two forms of birth control. Supports the restriction against alcohol during treatment and for two months after stopping, to prevent conversion to a longer-lasting related compound. Supports common side effects including hair loss, dry skin and mouth, bleeding gums, nosebleeds, peeling fingertips, mood changes, headache, joint pain, night-vision changes, and elevated liver enzymes. Supports the three-year blood-donation restriction after stopping treatment.
What it does not support
Does not report a psoriasis-specific clinical-trial population size, does not report an exact reaction rate, and does not assess an individual reader’s risk.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- U.S. National Library of Medicine (DailyMed)Regulatory · Regulatory / guideline, tier 1Independent source
- Published
- SteadySkin last checked
What this source can and cannot tell you
What this source supports
Supports the boxed warning that Soriatane must not be used by anyone who is pregnant, or who intends to become pregnant at any time within three years of stopping. Supports contraindication in patients with severely impaired liver or kidney function, or abnormally elevated blood lipids, and contraindication for concurrent methotrexate (hepatitis risk) or tetracyclines (intracranial pressure risk). Supports that vitamin A and other oral retinoids must be avoided concurrently, and that phototherapy doses must be reduced when combined with Soriatane because of an increased burn risk. Supports initial dosing of 25 to 50 mg per day as a single dose with the main meal, with maintenance dosing adjusted by individual response. Supports the requirement for two negative pregnancy tests before starting, and two effective forms of birth control for at least one month before through three years after treatment. Supports a repeated pregnancy test every three months during that three-year window. Supports the alcohol restriction for female patients of reproductive potential during treatment and for two months after, due to conversion to a longer-lasting related compound. Supports common reactions in more than three-quarters of patients (cheilitis, dry eyes, skin peeling, dry skin, hair loss, nail disorder, joint pain). Supports serious reactions including hepatitis, pancreatitis, a pressure buildup around the brain, and depression. Supports liver-function and lipid testing before treatment and every one to two weeks until levels are stable.
What it does not support
This label, as currently published, does not itself state a fixed outer limit on how long a course of psoriasis treatment may run; it states only that maintenance dosing is adjusted by response. Does not predict an individual reader’s dose or response.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.
- GoodRxPatient education · Patient education, tier 5Relevant relationship disclosed
- Published
- SteadySkin last checked
What this source can and cannot tell you
Why the independence label says this: GoodRx is a commercial pharmacy-price and coupon marketplace. Displayed prices can vary by prescription, pharmacy, location, and time.
What this source supports
Supports only the dated retail-cash and coupon-discount price recorded for 30 capsules of generic acitretin 25 mg: an average retail cash price of $902.27, and an average GoodRx-coupon price of $89.19.
What it does not support
It does not guarantee availability, coverage, coupon eligibility, or a personal price.
Claim-specific review for this source is still in progress. Only the source-level evidence and limits are shown here.