Acitretin is an oral retinoid doctors prescribe for severe psoriasis and some stubborn skin conditions. It can work well when topicals fail, but it comes with important risks — especially for women who could become pregnant. Read this for clear, practical steps on what to expect, how to lower risks, and when to call your clinician.
Acitretin helps normalize skin cell growth and reduce thick, scaly plaques. Most people start to see changes in a few weeks, but noticeable improvement often takes 2–3 months. Typical doses range from 10–50 mg daily; your doctor will pick a dose based on how severe your condition is and how you tolerate the drug. If you feel better, the dose may be adjusted down.
Common short-term effects include dry lips, dry skin, nosebleeds, and mild hair thinning. Some people also report increased sensitivity to sunlight. These are usually manageable with moisturizers, lip balm, and sunscreen, but mention them at your next visit so your provider can help.
Acitretin can cause liver and lipid changes, so your doctor will test liver function and fasting lipids before starting and on a schedule after that. If liver enzymes or triglycerides rise too high, your provider will change the dose or stop the medicine.
If you can get pregnant, do not take acitretin. It causes severe birth defects. You must have a negative pregnancy test before starting and use reliable contraception during treatment and for 3 years after stopping. Avoid alcohol while on acitretin and for a period after stopping — alcohol can change the drug into etretinate, which stays in the body longer and raises pregnancy risk.
Other important interactions and cautions: do not combine acitretin with vitamin A supplements (risk of toxicity), avoid tetracycline antibiotics and excessive vitamin A, and use caution with methotrexate because of added liver risk. Don’t donate blood while taking acitretin and for 3 years after stopping.
Watch for red flags: severe stomach pain, persistent nausea, yellowing skin, extreme fatigue, sudden severe back or muscle pain, or major mood changes. These need prompt medical attention.
If acitretin doesn’t suit you, there are options: topical treatments, phototherapy, methotrexate, cyclosporine, and the newer biologic drugs. Talk with your dermatologist about pros and cons based on your health, plans for pregnancy, and treatment goals.
Quick checklist before starting: baseline blood tests (LFTs and lipids), negative pregnancy test if applicable, clear contraception plan, stop alcohol, and remove vitamin A supplements. Follow-ups are key — regular tests and open communication keep treatment safe and effective.
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