Retinoid Treatment.

Generic name: Acitretin

Brand name:  Soriatane.

Acitretin or soriatane is an oral second generation retinoid which is typically used in the treatment of psoriasis.

What is a Retinoid.  Retinoids are synthetic vitamin A chemical compounds which regulate the growth of the epithelial skin cells and also affect the immune system.

Retinoids Uses.

• Acitretin is indicated in severe psoriasis which has not responded to topical treatment and light treatment. Acitretin is used in adults with severe guttate, plaque, pustular, erythrodermic and palmoplantar psoriasis.
• Acne
• Skin cancers
• Other inflammatory skin disorders.
• Photoaging. This is the term used for skin changes caused by chronic exposure to UVA and UVB light rays.

Dosage of Retinoids.

Soriatane is available in tablets of 10 mg and 25 mg. The dose of soriatane is determined by the attending dermatologist and depends on several factors including the type of psoriasis. The prescribed dose is usually given once a day with food. The dose is reduced once the symptoms start showing improvement and the drug is stopped when the lesions show significant improvement. When the psoriasis symptoms reappear, soriatane can be started again.

Therapeutic Effect of Retinoids.

Acitretin is modestly effective against psoriasis. The action of acitretin is slow and the symptoms may worsen after starting the drug. It may take 8 to 16 weeks before improvement is seen and up to 6 months for the drug to show its peak effect. Retinoids are more effective when used in combination with phototherapy.

Side effects of Retinoids.

Side effects of retinoids (acitretin)include

• Dryness of mouth and the mucus membranes,
• Cracking of the lips,
• Bleeding from gums and nose,
• Increased sensitivity to sunlight,
• Itching of the skin
• Loss of hair.
• Depression,
• Headache,
• Joint pains,
• Increased fat levels,
• Hepatitis leading to increase in levels of liver enzymes.
• Pancreatitis which can cause abdominal pain.

Contraindications for  Retinoids.

1) Allergy to retinoids.

2) High triglyceride levels in blood.

3) Severely damaged liver or kidneys due to diseases.

4) Retinoids and Pregnancy.

Two pregnancy tests should test negative before starting a woman of child bearing age on retinoids (acitretin). Acitretin or Soriatane produces serious congenital defects in the developing foetus. Soriatane should not be taken for at least three years before planning a pregnancy. For the same reason, a woman must take effective birth control measures at least one month before starting  acitretin to avoid getting pregnant.

Birth control pills containing only progestin may not work when on acetretin and therefore other measures should be adopted. Again a patient on acetretin should not donate blood for three years after having stopped this medicine as that blood could be used to transfuse a pregnant woman. Women on acetretin should avoid taking alcohol or preparations containing alcohol.

Retinoid Cream.

Retinoid creams or topical retinoids are used in the treatment of  psoriasis, acne and sun burnt skin. Tazarotene (Tazorac, Awage)  is specifically indicated for treating moderate plaque psoriasis. It contains a compound similar to vitamin A and acts by slowing down the over production of the skin cells and also reduces skin inflammation. It does this by normalizing the activity of the DNA of the skin cells.

Side effects include skin irritation and increased sensitivity to sunlight. Sun screens are advised if you have to venture out into sunlight after this has been applied. Although risk of congenital birth defects are minimal with these topical applications, its use during pregnancy and breast feeding is not recommended. Similarly its use in children is restricted.

Retinoid Products.

Retinoid products are available for oral use and for topical applications.

Oral retinoids:

• Soriatane for use in psoriasis.
• Vitamin A derivative isotretinoin for use in acne. It is marketted as Roaccutane, Accutane, Amnesteem, Sotret, Claravis, Clarus.

Retinoid creams or topical retinoids.

• Tazarotene used for psoriasis and available as Tazorac and Awage creams.
• Tretinoin  available as Retin-A cream, Atralin, Avita and  Adapalene available as Differin used in treating acne vulgaris.

Of these Tazarotene is the stronger form while Adapalene is the milder and less effective form of retinoid.

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