Acitretin Capsules for Psoriasis (Neotigason)
Comprehensive guide to acitretin (Neotigason) for treating severe psoriasis and related skin conditions effectively.
Acitretin, marketed as Neotigason, is a retinoid medication that treats severe psoriasis by normalizing skin cell growth and reducing thick, scaly patches.
About acitretin
| Type of medicine | A retinoid medicine (similar to vitamin A) |
|---|---|
| Used for | Severe psoriasis and some other skin conditions |
| Also called | Neotigason® |
| Available as | Capsules (10 mg and 25 mg) |
Acitretin belongs to the retinoid class, compounds related to vitamin A essential for healthy skin maintenance. In psoriasis, skin cells multiply too rapidly, leading to buildup of thick, scaly patches. Acitretin modulates epidermal keratinocyte proliferation: antiproliferative in hyperproliferative psoriatic plaques, reducing desquamation, erythema, and lesion thickness, while promoting normal growth in healthy tissue.
It is indicated for severe extensive psoriasis resistant to other therapies, palmoplantar pustular psoriasis, severe congenital ichthyosis, and Darier’s disease. Due to no direct immunosuppression and potential for long-term response, it plays a key role despite slower onset.
Acitretin excels in hyperkeratotic forms where desquamation predominates, as a first-line for pustular psoriasis (especially palmoplantar), and in combination/sequential regimens. It shows efficacy in nail psoriasis, with studies reporting 41% NAPSI score reduction at 0.2-0.3 mg/kg/day for 6 months.
How to take acitretin
Follow the manufacturer’s leaflet and doctor’s instructions precisely. Swallow capsules whole with water during or after a meal to enhance absorption, as fat-soluble.
Dosage: Starting dose is typically 25-30 mg daily (1 x 25 mg or 3 x 10 mg) for adults/elderly. Adjust based on response: up to 75 mg/day max, but often 0.25-1 mg/kg/day. For pustular psoriasis, 0.5-1 mg/kg/day yields rapid response (clearing in ~10 days), then taper to 10 mg maintenance. In generalized pustular psoriasis, 84% efficacy reported.
Benefits start in 2-4 weeks, peak at 2-4 months. Courses last up to 6 months, but longer-term use safe per clinical experience despite SPC limits; no substantial adverse increase noted.
- Take consistently at the same time daily.
- Do not exceed prescribed dose.
- If dose missed, take soon as remembered unless near next; do not double.
- Improvement: skin peels or clears gradually.
Getting the most out of your treatment
Use emollients liberally for dryness. Avoid vitamin A supplements or retinoid-containing products. Check interactions with doctor/pharmacist.
Sun protection crucial: skin photosensitive. Use high-SPF sunscreen (SPF 30+), cover up, avoid sunbeds. Initial psoriasis worsening possible.
Can acitretin cause problems?
Common side effects often mild, improve with time/dose reduction. Use table below for management.
| Common side-effects | Frequency | What can I do if I experience this? |
|---|---|---|
| Dry skin and lips, peeling | Very common (>1 in 10) | Use moisturising cream and lip balm regularly. New skin post-peeling often normalises |
| Tummy pain, nausea, diarrhoea | Common (1 in 100) | Simple meals, plenty fluids |
| Muscle/joint pain | Common | Inform doctor for checks |
| Headache | Common | Hydrate, suitable painkiller; persist > doctor |
| Dry nose, nosebleeds, brittle nails, hair loss, mood changes | Common | Doctor if troublesome |
Rare serious effects: hypertriglyceridemia, hepatotoxicity (monitor bloods monthly initially), teratogenicity. Stop if severe.
Special precautions with acitretin
Pregnancy and contraception
Critical: Major teratogen; causes severe fetal abnormalities. Effective contraception mandatory 1 month before, during, and 3 years post-treatment (long half-life from etretinate conversion).
- Women: Two reliable methods (e.g., pill + barrier); monthly pregnancy tests.
- No pregnancy if partner on acitretin.
- Males: Unaffected fertility/offspring.
Blood donation
Women: Avoid donating blood during + 3 years after. Men: 3 months post.
Driving and machinery
May cause dizziness/headache; avoid if affected.
Alcohol
Avoid; increases etretinate levels, prolongs teratogenic risk.
Monitoring
Baseline + regular blood tests (liver, lipids, blood count). Initial psoriasis flare possible.
Interactions with acitretin
Avoid vitamin A, tetracyclines (intracranial pressure risk), methotrexate (hepatotoxicity). Inform doctor of all meds.
Other information about acitretin
Store below 25°C. Expires per pack. Overdose: Seek immediate help. Report side effects via Yellow Card.
Frequently asked questions about acitretin
Will acitretin cure my psoriasis?
No, controls symptoms; relapse possible on stopping. Maintenance may sustain response.
How long until it works?
2-4 weeks onset, 2-4 months max benefit.
Is long-term use safe?
Yes, per experience; no major adverse rise beyond 6 months.
Can I drink alcohol?
No, risks prolonged teratogenicity.
Safe for men wanting children?
Yes, no fertility/offspring effects.
What if skin worsens initially?
Common; persists > consult doctor.
Effective for nail psoriasis?
Yes, significant NAPSI improvement in studies.
References
- Guidelines for the Use of Acitretin in Psoriasis — Actas Dermo-Sifiliográficas. 2014-01-01. https://actasdermo.org/en-acitretina-guia-uso-psoriasis-articulo-S1578219013001479
- Acitretin capsules for psoriasis (Neotigason) — Patient.info. Recent access 2026. https://patient.info/medicine/acitretin-capsules-for-psoriasis-neotigason
- Neotigason Capsules — NPS MedicineWise (Australian Therapeutic Goods Administration funded). Recent. https://www.nps.org.au/medicine-finder/neotigason-capsules
- Acitretin: Drug Information — DermNet NZ (New Zealand Dermatological Society). Recent. https://dermnetnz.org/topics/acitretin
- Acitretin (Neotigason) Patient Information — Sussex CDS (NHS). Recent. https://sussexcds.co.uk/patient-information/acitretin-neotigason/
- Neotigason 10mg and 25mg Capsules PIL — medicines.org.uk (MHRA/EMC). 2023-01-01. https://www.medicines.org.uk/emc/files/pil.10247.pdf
- Neotigason 10 mg capsules SPC — HPRA (Health Products Regulatory Authority Ireland). Recent. https://assets.hpra.ie/products/Human/27148/466d270c-5298-4897-9ec0-8c4ca2c22ee2.pdf
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