🍽️ acitretin,(prescription)

Retinoid Derivative: Acitretin is a synthetic retinoid derivative of vitamin A (retinol) that modulates cellular differentiation, proliferation, and inflammation in the skin. It exerts its therapeutic effects by binding to nuclear receptors and regulating gene expression involved in keratinocyte differentiation and epidermal turnover.

Treatment of Psoriasis: Acitretin is indicated for the treatment of severe psoriasis, including plaque psoriasis, pustular psoriasis, and erythrodermic psoriasis, which are resistant to or not adequately controlled by other therapies. It helps reduce the severity and extent of psoriatic lesions, alleviate symptoms such as scaling and itching, and improve overall quality of life.

Psoriatic Arthritis: Acitretin may also be used as an adjunctive therapy in the management of psoriatic arthritis, a chronic inflammatory arthritis associated with psoriasis. While acitretin primarily targets cutaneous manifestations of psoriasis, it may provide additional benefits in patients with psoriatic arthritis by reducing skin involvement and inflammation.

Mechanism of Action: The exact mechanism of action of acitretin in psoriasis is not fully understood, but it is thought to involve normalization of abnormal keratinocyte proliferation and differentiation, suppression of inflammatory cytokines, and modulation of immune responses in the skin.

Long-term Therapy: Acitretin is typically used as a long-term therapy for psoriasis, often in combination with other treatments such as topical corticosteroids, phototherapy (UVB or PUVA), or biologic agents. Long-term maintenance therapy with acitretin may help control psoriatic symptoms and prevent disease relapse.

Dosage and Administration: Acitretin is administered orally in the form of capsules. The dosage and duration of treatment depend on the severity of the psoriasis, individual patient response, and tolerability. It is usually initiated at a low dose and titrated gradually to achieve optimal therapeutic effects while minimizing side effects.

Side Effects: Common side effects of acitretin may include dry skin, cheilitis (inflammation of the lips), pruritus (itching), hair loss, and photosensitivity (increased sensitivity to sunlight). Other potential side effects may include mucocutaneous effects (e.g., conjunctivitis, dry eyes), hepatotoxicity (liver damage), hyperlipidemia (elevated lipid levels), and teratogenicity (birth defects).

Contraindications and Precautions: Acitretin is contraindicated in pregnant women or women of childbearing potential due to its teratogenic effects. Female patients of childbearing age must use effective contraception before, during, and for at least three years after discontinuing acitretin therapy. It is also contraindicated in patients with severe hepatic or renal impairment.

Monitoring: Patients receiving acitretin therapy require regular monitoring of liver function tests, lipid levels, and signs of adverse effects such as mucocutaneous symptoms or mood changes. Monitoring is particularly important during long-term treatment to detect and manage potential side effects.

Discontinuation and Withdrawal: Acitretin therapy should be discontinued gradually, and patients should be monitored for potential rebound flare-ups of psoriasis or exacerbation of symptoms upon discontinuation. A washout period may be necessary before starting alternative therapies, especially in patients switching to medications with overlapping toxicities.