Acitretin

How it works

As a vitamin A derivative it modulates epidermal cell proliferation and differentiation, normalising the abnormal keratinisation and hyperproliferation seen in psoriasis.

Prescribing in practice

• It is a potent teratogen and is contraindicated in pregnancy, requiring reliable contraception during treatment and for an extended period afterwards under a pregnancy prevention approach.
• It can cause hepatotoxicity and marked elevations in serum lipids, so liver function and lipids must be assessed before and during treatment.
• Alcohol should be avoided during and for a period after therapy because it can promote conversion to a longer-lived teratogenic metabolite, and blood donation is contraindicated.

Monitoring

Monitor liver function and fasting lipids regularly, alongside pregnancy testing where applicable.

Counselling the patient

• Effective contraception is essential during treatment and for the full advised period after stopping.
• Avoid alcohol and do not donate blood during and after treatment as directed.
• Expect dry lips, skin and eyes, and report visual disturbance or persistent headache.

Evidence & guidelines

Acitretin is an established systemic option for severe psoriasis, and MHRA pregnancy prevention requirements for oral retinoids govern its prescribing.