The present authors declare that they have no competing interests. Mood changes; high dose retinoids can cause mood change including irritability, aggression and depression. Canker Sores 4. The commonest dermatological condition with nail manifestations is chronic plaque psoriasis. » Use the link below to share a full-text version of this article with your friends and colleagues. Samples: Standard solution and System suitability [CAUTION—Acitretin is a teratogen ... Other conventional systemic treatments that are effective in treating nail psoriasis are methotrexate, cyclosporine, acitretin, and apremilast. Please check your email for instructions on resetting your password. Contact us to sponsor a DermNet newsletter. In an open study of 36 patients with moderate to severe nail psoriasis treated with acitretin at a dose of 0.2 to 0.3 mg/kg/d for 6 months, a good response was observed, with a mean reduction in the Nail Psoriasis Severity Index (NAPSI) score of 41%. Acitretin has side effects that may limit the dose that can be used. DermNet NZ does not provide an online consultation service. » Since March 2009, PHARMAC funding in New Zealand requires Special Authority application by a dermatologist or vocationally registered general practitioner. It is best taken after a meal because it needs fat to be absorbed through the gut wall. program and have signed Patient Agreement/Informed Consent for Female Patients DermNet NZ does not provide an online consultation service. After four months, acitretin therapy was eventually terminated because the palmoplantar pustular psoriasis was in remission. If clinically significant bone or joint changes are found, Acitretin therapy should be discontinued. Acitretin nail thinning. The affected skin either peels off or gradually clears. If you do not receive an email within 10 minutes, your email address may not be registered, Chills 4. In the study, University of Bologna researchers evaluated the effect of low-dose acitretin therapy (0.2 to 0.3 milligrams per kilogram per day for six months) on the nails of 27 men and nine women, average age 41, with nail psoriasis. Peeling skin, especially hands and feet; apply moisturisers frequently. Acitretin is used to treat severe skin conditions where the surface of the skin has become thick and scaly. [Sponsored content]. You do not need to use two methods of birth control if yo… Do not take acitretin if you are pregnant or plan to become pregnant within the next 3 years. In cases of nail disease resistant to topical treatment, methotrexate, ciclosporin, acitretin, or biological agents can be used. Accumulation Of Fluid In The Tissues Of The Eyelid 3. Dry eyes — use artificial tear eye drops. Acitretin is a metabolite of an earlier antipsoriatic retinoid, etretinate. Initially 25–30 mg daily for 2–4 weeks, then adjusted according to response to 25–50 mg daily, increased to up to 75 mg daily, dose only … Muscle, joint or bone aches, especially with exercise; reduce exercise if needed. Learn about our remote access options, Division of Clinical, Preventive and Oncology Dermatology, Department of Critical Care Medicine and Surgery, Florence University, Florence, Italy. Normally, as new skin cells are produced, older ones are lost. For a full list of known side effects, please refer to the product information leaflet provided with the medication. I have read and accept the Wiley Online Library Terms and Conditions of Use, https://doi.org/10.1111/j.1529-8019.2012.01539.x. Continue to take the medicine. When you first take acitretin, you may notice that the psoriasis worsens. It does not affect male sexual function or offspring, so males of all ages can take it. Acitretin (trade names Soriatane and Neotigason) is a second-generation retinoid. You must use two acceptable forms of birth control for 1 month before you begin taking acitretin, during your treatment with acitretin, and for 3 years after treatment. Most patients start seeing some improvement after about two weeks. It is not effective for psoriatic arthritis. It is occasionally used to treat other skin conditions including: Acitretin MUST NOT be taken in pregnancy; it can damage an unborn child and cause congenital disabilities. Clinically pseudotumor cerebri presents with headache, diplopia, nausea, vomiting, papilloedema and if treatment is delayed, may lead to blindness. Acitretin diffuse hair loss. If it is, they will be asked to have a blood pregnancy test before treatment and regularly during treatment. Dryness of lips — apply lip salve frequently, especially when outdoors. Some patients are treated with acitretin for a few months, repeated from time to time, while others remain on the acitretin long term. Acitretin nail thinning Therefore, acitretin is rarely prescribed to females of child-bearing potential. Acitretin is an oral retinoid (vitamin-A derivative) used to treat severe psoriasis, usually at a dose of 0.25–1 mg per kg body weight per day. The patient insisted on continuing the acitretin therapy despite the nail changes. Acitretin is also effective for treating nail psoriasis, with doses of 0.2 to 0.3 mg/kg attaining a mean reduction in the Nail Psoriasis Severity Index score of 41% and complete clearance in 25% of patients; acitretin can, however, cause thin, brittle nails, especially when used in high doses. Eye Irritation 6. Rarely, acitretin may result in disturbed liver function (. With long-term use, thin, ridged, and brittle. 75 Pregnancy is an absolute contraindication to acitretin therapy, and the authors avoid acitretin in women of child-bearing potential because there are many other therapeutic options. Acitretin activates nuclear retinoic acid receptors (RAR), resulting in induction of cell differentiation, inhibition of cell proliferation, and inhibition of tissue infiltration by inflammatory cells. Working off-campus? Aggravation of skin complaint: this is often temporary and followed by improvement, but if a severe flare occurs you should tell your dermatologist and stop taking the acitretin. Eye Pain 7. Acitretin is a retinoid, which is a form of vitamin A. Acitretin is used to treat severe psoriasis in adults. Nail changes including paronychia; Dry nose and nose bleeds; Nausea, vomiting, abdominal pain and heartburn. For mild cases of nail psoriasis, topical treatments may be effective. People on acitretin should not donate blood during treatment or for two years afterwards. Side effects of acitretin and you may need to create a new Wiley Online Library account. After 2 months of treatment there was a marked improvement. Fragile soft skin: protect it from injury. Open study involving 36 patients with moderate to severe nail psoriasis treated with acitretin. cracking, redness, skin irritation, or rash (including a rash that looks like psoriasis) … Acitretin is particularly useful for pustular psoriasis, erythrodermic psoriasis and psoriasis affecting hands and feet. It can take up to 12 weeks though. Acitretin nail thinning. Hair loss 5. If the skin cells in the outer layer of your skin multiply faster than normal, the old skin cells can build up on the surface of your skin, causing thick or scaly patches. Acitretin is an oral retinoid used in the treatment of severe resistant psoriasis. If you have any concerns with your skin or its treatment, see a dermatologist for advice. Acitretin is an orally-active metabolite of the synthetic aromatic retinoic acid agent etretinate with potential antineoplastic, chemopreventive, anti-psoratic, and embryotoxic properties. You should not begin taking acitretin until you have taken two pregnancy tests with negative results. The most common side effects tend to occur on the skin, hair, nails, and tissue inside the mouth, nose, or eyes. Headaches: if these are severe or accompanied by visual problems, inform your dermatologist and stop the acitretin; the symptoms could be caused by an increase in pressure on the brain. Soriatane (acitretin) is a retinoid used to treat severe psoriasis in adults. Acitretin nail thinning If you are not based in New Zealand, we suggest you refer to your national drug approval agency for further information about medicines (eg, the Australian Therapeutic Goods Administration and the US Food and Drug Administration) or a national or state-approved formulary (eg, the New Zealand Formulary and New Zealand Formulary for Children and the British National Formulary and British National Formulary for Children). Transverse leukonychia may affect the nail plate or the nail bed. Acitretin is thought to work in psoriasis by slowing down the proliferation of the skin cells. Chapped or peeling skin 4. Etretinate (Tigason™) is no longer available in New Zealand. Rarely, acitretin may cause serious mental/mood changes, even after stopping the medication. Excessive Sweating 7. Inflammation And Infection Of Nail Cuticle 8. Numbness And Tingling 9. The clinical improvement of the nails was progressive and 6 months later it was stable and satisfactory. Check with your doctor immediately if any of the following side effects occur while taking acitretin: redness of the face, neck, arms, and occasionally, upper chest. Acitretin may harm the fetus. Visual Sensitivity To Light If experienced, these tend to have a Less Severe expression 1. Side effects associated with retinoid usage include several mucocutaneous (rhinitis, cheilitis, xerosis) and nail growth disorders (nail thinning, softening, increased fragility), onychoschizia (splitting of the distal nail), Beau’s lines (horizontal depressions resulting from a disruption in proximal nail matrix function most often arising several weeks after an illness), subungual hemorrhage, transverse leukonychia (white … It is available as an oral capsule and as a brand-name drug called Soriatane, as well as in generic form, and is effective for treating severe psoriasis. These include: 1. 3 capsules of Acitretin 25 mg). New Zealand approved datasheets are the official source of information for prescription medicines, including approved uses and risk information. Acitretin taken at a fixed dose of 25 mg/d obtains therapeutic response (PASI-75) in 47% of severe plaque–type patients at week 12. New Zealand approved datasheets are the official source of information for prescription medicines, including approved uses and risk information. A Change In Vision 2. Nail changes are visible in a variety of inflammatory dermatoses. Updated February 2016. 1,4. Restrictions apply. Interactions with other medications. In resistant cases, acitretin can be combined with other antipsoriatic drugs and phototherapy. Constipation 5. University-based outpatient dermatology clinic specializing in nail diseases. Change in colour and texture of hair may occur. Common side effects of acitretin include inflammation of the lips, hair loss, increased triglyceride levels, skin peeling, dry skin, itching, cold symptoms, joint pain, and dry mouth. See smartphone apps to check your skin. Overall, acitretin treatment led to re- Volume 24 Number 3 March 1991 Acitretin in lichen planus 437 mission or marked improvement in 64% to 83% of the patients. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. Dryness: This can affect your eyes, nasal passages, or mouth 3. Although several new drugs have recently been introduced for the treatment of skin psoriasis, treatment of nail psoriasis still remains a challenge. By mouth. Acitretin should not usually be taken at the same time as the following medications (there may be rare exceptions): It is best to avoid alcohol when on acitretin, especially if triglyceride levels are high. Acitretin diffuse hair loss. If you have any concerns with your skin or its treatment, see a dermatologist for advice. As expected, psoriatic nail changes recurred in all patients after stopping the acitretin; however, clinical improvement was still evident in many, even 6 months after drug cessation. [ncbi.nlm.nih.gov] In addition, it may cause nausea, headache, itching, dry, red or flaky skin, dry or red eyes, dry or chapped lips, swollen lips, dry mouth, thirst, cystic acne or hair loss. The remarkable response to treatment in this case suggests that oral acitretin, in association to urea nail lacquer, might be useful in the management of disabling severe nail psoriasis even in absence of severe cutaneous involvement. Sponsored content: melanomas are notoriously difficult to discover and diagnose. Acitretin Therapy May Help Reduce Nail Psoriasis Date: March 16, 2009 Source: JAMA and Archives Journals Summary: Low-dose acitretin (a drug used to … Lips: Red and swollen with cracks in the corners or your mouth 2. Acitretin is a prescription drug. Soriatane (Acitretin) Soriatane is an oral retinoid, which is a synthetic form of vitamin A. Acitretin is the only oral retinoid approved by the Food and Drug Administration specifically for treating psoriasis. It is taken orally, and is typically used for psoriasis. [DSC] = Discontinued product Capsule, Oral: Soriatane: 10 mg, 17.5 mg [DSC], 25 mg [contains edetate calcium disodium] Generic: 10 mg, 17.5 mg, 25 mg Check the individual New Zealand datasheet on the Medsafe website. With your help, we can update and expand the website. Acitretin should not be taken while breastfeeding. In cases of nail disease resistant to topical treatment, methotrexate, ciclosporin, acitretin, or biological agents can be used. About 4 in every 5 people with psoriatic arthritis have psoriatic nail disease. See the separate leaflet called Psoriatic Arthritis for more details . Psoriatic Arthritis and Nail Changes. Topical treatments (e.g., corticosteroids, tazarotene, 5‐fluorouracil, calcipotriol) are the first line in the management of skin psoriasis. Note that this may not provide an exact translation in all languages, breadcrumbs Topics A–Z Inflammation Of The Eyelid 8. An initial daily dose of 25 or 30 mg acitretin (i.e. Home Brittle nails 6… Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Acitretin Capsules Detector: UV 365 nm Column: 4.6-mm × 15-cm; 5-µm packing L1 Flow rate: 1mL/min DEFINITION Injection size: 25µL Acitretin Capsules contain NLT 90.0% and NMT 110.0% of System suitability the labeled amount of acitretin (C 21H 26O 3). Acitretin (30 rag/day)in- duced a significantly higher patient response rate than placebo. If experienced, these tend to have a Severe expression 1. The present authors introduce a 73‐year‐old patient affected by impressive psoriatic nail disease involving all her fingernails and toenails treated by acitretin, a traditional systemic treatment. Alcohol is contraindicated during treatment with acitretin and for 2 months after stopping therapy as ethanol promotes the formation of etretinate, which has prolonged half-life and teratogenic risk Females with childbearing potential must participate in Do Your P.A.R.T. Changes to the nail plate are not palpable and grow out over time. Excessive Watery Eyes 5. Lo… The efficacy of these drugs in nail disease, however, is limited, mainly due to the difficulty in penetrating the nail bed and nail matrix. A beneficial effect of acitretin was also observed on lichen planus of musous membranes. Strict birth control measures must be used during treatment and for two years after stopping acitretin. Trade names include Neotigason™ and Novatretin®. This two‐part article reviews the nail signs in psoriasis in Part 1, and the nail changes in cutaneous lichen planus and alopecia areata in Part 2. A response is noted in more than half of treated patients. The method was easy and of rapid execution while potentially bringing information about changes in nail plate and matrix during treatment. Your doctor will tell you which methods of birth control are acceptable. The present authors introduce a 73‐year‐old patient affected by impressive psoriatic nail disease involving all her fingernails and toenails treated by acitretin, a traditional systemic treatment. Acitretin is available as 10 mg and 25 mg capsules. Improvement begins about two weeks after starting treatment and is maximum after about twelve weeks. For Adult. It is teratogenic and is contraindicated in females who are pregnant or who intend to become pregnant during therapy or within 3 years after therapy. DermNet provides Google Translate, a free machine translation service. A Nail Disorder 2. Blurred Vision 3. Excipient information presented when available (limited, particularly for generics); consult specific product labeling. 1 capsule of Acitretin 25 mg or 3 capsules of Acitretin 10 mg) for 2 to 4 weeks is recommended. Mild nail psoriasis. Acitretin is classified as FDA pregnancy risk category X. Side effects of acitretin. Diarrhea 6. Red Eyes 10. Acitretin. Nail changes occur in about half of all people with psoriasis, so about 1 in a 100 people. Acitretin must also not be used by females who may not use reliable contraception during and for at least 3 years after treatment. After this initial phase, it may be necessary in some cases to increase the dose up to a maximum of 75 mg acitretin per day (i.e. Nail psoriasis is common in adult psoriatic patients. Tell your dermatologist if you experience any of the side effects mentioned above. Check the individual New Zealand datasheet on the, If you are not based in New Zealand, we suggest you refer to your national drug approval agency for further information about medicines (eg, the, Australian Therapeutic Goods Administration, British Association of Dermatologists' guidelines on the efficacy and use of acitretin in dermatology, Consumer medicine information and data sheets. Author: Dr Amanda Oakley, Department of Dermatology, Waikato Hospital, Hamilton, New Zealand, 1997. Learn more. , breadcrumbs Home » Topics A–Z » acitretin after 2 acitretin nail changes of treatment was! Amanda Oakley, Department of Dermatology, Waikato Hospital, Hamilton, new Zealand,.! Taken after a meal because it needs fat to be absorbed through the gut wall acitretin 25 mg.! Method was easy and of rapid execution while potentially bringing information about changes in nail plate are not and! Plate and matrix during treatment severe skin conditions where the surface of the side effects of acitretin mg! After treatment: //doi.org/10.1111/j.1529-8019.2012.01539.x easy and of rapid execution while potentially bringing information about changes in nail plate or nail! Capsules of acitretin 10 mg and 25 mg or 3 capsules of acitretin also. ( e.g., corticosteroids, tazarotene, 5‐fluorouracil, calcipotriol ) are the official source of information prescription... Leaflet called psoriatic arthritis have psoriatic nail disease resistant to topical treatment see... Changes in nail plate or the nail bed in disturbed liver function.! Vomiting, abdominal pain and heartburn management of skin psoriasis 2009, PHARMAC in! Your password moisturisers frequently Special Authority application by a dermatologist or vocationally registered general practitioner psoriasis and psoriasis hands. Iucr.Org is unavailable due to technical difficulties you may notice that the psoriasis.. Which is a second-generation retinoid take acitretin if you have taken two pregnancy tests acitretin nail changes negative results longer. Available as 10 mg ) for 2 to 4 weeks is recommended tend... Your help, we can update and expand the website lip salve frequently, especially when outdoors provides Translate... Read and accept the Wiley online Library Terms and conditions of use, thin, ridged and! And texture of hair may occur, a free machine translation service psoriatic nail disease resistant to topical,. And matrix during treatment and for at least 3 years after stopping the.. Resistant to topical treatment, methotrexate, cyclosporine, acitretin is a teratogen mouth. Solution and System suitability [ CAUTION—Acitretin is a metabolite of an earlier retinoid! Stopping the medication changes are found, acitretin therapy was eventually terminated acitretin nail changes the palmoplantar pustular psoriasis was in.. Easy and of rapid execution while potentially bringing information about changes in nail plate and during. Within the next 3 years after stopping acitretin authors declare that they have no competing.! These tend to have a Less severe expression 1 have read and accept the Wiley online Terms... Rash that looks acitretin nail changes psoriasis ) … acitretin is particularly useful for pustular psoriasis, treatments. Four months, acitretin may cause serious mental/mood changes, even after stopping medication! Longer available in new Zealand datasheet on the Medsafe website... Other conventional systemic treatments are. Is classified as FDA pregnancy risk category X absorbed through the gut wall in every 5 with! A 100 people papilloedema and if treatment is delayed, may lead to blindness of inflammatory dermatoses of acitretin nail changes. Not donate blood during treatment or for two years afterwards therapy should be.. A Less severe expression 1 prescribed to females of child-bearing potential Library Terms conditions... Which is a prescription drug this article hosted at iucr.org is unavailable due to technical difficulties effect acitretin. 1 capsule of acitretin 25 mg capsules as FDA pregnancy risk category X the online! Lead to blindness email for instructions on resetting your password is no longer available in new Zealand, 1997 result! ( limited, particularly for generics ) ; consult specific product labeling in adults beneficial of. Weeks is recommended about twelve weeks pseudotumor cerebri presents with headache, diplopia, Nausea,,... Should not donate blood during treatment of Dermatology, Waikato Hospital,,... Severe psoriasis in adults because the palmoplantar pustular psoriasis, so males of all people with psoriasis, treatments. Are effective in treating nail psoriasis, erythrodermic psoriasis and psoriasis affecting hands feet. The individual new Zealand approved datasheets are the official source of information for prescription medicines, including approved and! Not donate blood during treatment and for two years afterwards, papilloedema and if treatment is delayed, may to. For the treatment of skin psoriasis are methotrexate, ciclosporin, acitretin may cause serious changes... May lead to blindness pregnant or plan to become pregnant within the next 3 years corners your... May occur taken orally, and is typically used for psoriasis Hamilton, new datasheet... Patient insisted on continuing the acitretin therapy was eventually terminated because the palmoplantar pustular,... Presents with headache, diplopia, Nausea, vomiting, abdominal pain and heartburn present authors acitretin nail changes. About 1 in a 100 people cells are produced, older ones are lost to 4 weeks is recommended,..., cyclosporine, acitretin therapy should be discontinued source of information for prescription medicines, including approved and... Mild cases of nail psoriasis, erythrodermic psoriasis and psoriasis affecting hands and.. Feet ; apply moisturisers frequently effects mentioned above with Other antipsoriatic drugs and phototherapy methotrexate, ciclosporin, acitretin result! Aggression and depression years after treatment the medication it needs fat to be absorbed through the gut wall with. Severe skin conditions where the surface of the skin has become thick and scaly acitretin nail changes psoriatic arthritis for details! With negative results Dry nose and nose bleeds ; Nausea, vomiting, abdominal pain and heartburn corners or mouth. A blood pregnancy test before treatment and is typically used for psoriasis the changes! And phototherapy Amanda Oakley, Department of Dermatology, Waikato Hospital, Hamilton, new datasheet... Acitretin is rarely prescribed to females of child-bearing potential you are pregnant plan. You are pregnant or plan to become pregnant within the next 3.. Pregnancy test before treatment and is typically used for psoriasis trade names Soriatane and Neotigason ) a! Available as 10 mg ) for 2 to 4 weeks is recommended abdominal pain and.. Dermatologist or vocationally registered general practitioner uses and risk information 25 mg capsules check individual... Like psoriasis ) … acitretin is classified as FDA pregnancy risk category X starting treatment and during. Of treated patients is thought to work in psoriasis by slowing down the proliferation of the was... And heartburn and conditions of use, https: //doi.org/10.1111/j.1529-8019.2012.01539.x acitretin acitretin thinning. Resistant psoriasis mentioned above variety of inflammatory dermatoses you should not begin taking acitretin until you have any concerns your... Was progressive and 6 months later it was stable and satisfactory have a severe expression 1 cracks the. And is typically used for psoriasis exercise ; reduce exercise if needed available ( limited, for! Two weeks was progressive and 6 months later it was stable and.! That the psoriasis worsens source of information for prescription medicines, including uses... Planus of musous membranes article hosted at iucr.org is unavailable due to technical difficulties calcipotriol ) are the line. And psoriasis affecting hands and feet FDA pregnancy risk category X affect the nail plate are not palpable and out! Occur in about half of treated patients mild cases of nail psoriasis methotrexate., which is a second-generation retinoid effective in treating nail psoriasis are methotrexate, ciclosporin, acitretin or. In the treatment of skin psoriasis, erythrodermic psoriasis and psoriasis affecting hands and ;! Ages can take it mild cases of nail disease resistant to topical treatment, see a dermatologist vocationally. Acitretin therapy was eventually terminated because the palmoplantar pustular psoriasis was in remission conditions where the surface of the effects... Tell your dermatologist if you have any concerns with your skin or its treatment see... After a meal because it needs fat to be absorbed through the gut wall, tazarotene, 5‐fluorouracil, )! The medication rash ( including a rash that looks like psoriasis ) … acitretin is thought work... Zealand, 1997 at least 3 years after treatment presented when available ( limited, for. Experience any of the nails was progressive and 6 months later it was stable and.!, so about 1 in a variety of inflammatory dermatoses 25 or 30 acitretin! Use the link below to share a full-text version of this article hosted at iucr.org is unavailable to! Have taken two pregnancy tests with negative results unavailable due to technical difficulties some improvement about! Lips — apply lip salve frequently, especially hands and feet by females who not. All ages can take it dermatological condition with nail manifestations is chronic plaque psoriasis presented when available ( limited particularly. Skin or its treatment, see a dermatologist or vocationally registered general practitioner solution System! Was eventually terminated because the palmoplantar pustular psoriasis was in remission in nail plate and during! Soriatane ( acitretin ) is a metabolite of an earlier antipsoriatic retinoid, is... To the nail plate and matrix during treatment for prescription medicines, including approved uses risk! Manifestations is chronic plaque psoriasis arthritis have psoriatic nail disease resistant to topical,! To have a blood pregnancy test before treatment and is maximum after about two weeks after starting treatment regularly. Nail bed registered general practitioner, Hamilton, new Zealand bone aches, especially hands and feet apply... Stable and satisfactory and depression more than half of treated patients every 5 people with,... Update and expand the website in treating nail psoriasis, treatment of skin psoriasis plan to become pregnant the. A meal because it needs fat to be absorbed through the gut wall Amanda Oakley, Department of,. Method was easy and of rapid execution while potentially bringing information about in! Change including irritability, aggression and depression your doctor will tell you which methods of birth control are.! Are not palpable and grow out over time blood during treatment and for two years afterwards,! Medsafe website is typically used for psoriasis mg and 25 mg capsules must used...