Retinoids (Acitretin [Soriatane])
Description
Oral retinoids are sometimes used for autoimmune skin diseases. The most common disease they are used for is cutaneous lupus erythematosus (LE). Oral retinoids are a class of medications that are derivatives of vitamin A. First generation retinoids include isotretinoin (Accutane) and alitretinoin. Acitretin (Soriatane) is a second-generation retinoid. Oral retinoids can decrease inflammation in the skin.
Fast Facts
- Oral retinoids are used to treat refractory cases of cutaneous LE
- Liver function tests and lipids of patients taking retinoids should be carefully monitored
- Patients taking retinoids must avoid pregnancy
- Patients taking retinoids must notify their doctor if they develop a headache
Uses
Oral retinoids are used to treat refractory cutaneous LE. This can include discoid LE, subacute cutaneous LE, hypertrophic LE, and LE/Lichen planus overlap.
How it works
Retinoids comprise a family of drugs with structures and mechanisms of action that are similar to but stronger than vitamin A. They work by having affects on cell growth and differentiation.
Dosing
Acitretin is given at doses of 0.2-1 mg/kg body weight per day, with medications available in 15 and 25 mg size. It is given once a day. Isotretinoin is given at doses of 0.5-1.0 mg/kg body weight per day. It should not be taken if planning pregnancy, you are pregnant, you have just become pregnant, you are breastfeeding, you have severe liver or kidney disease, or you have high blood fat levels (triglycerides).
Time to effect
Retinoids work in 2-8 weeks, but in only about half of patients with cutaneous LE.
Side effects
Common side effects include dry eyes, dry mouth, and dry skin. Increased blood lipids and liver toxicity are also common with retinoid use. Less frequently there can be hair loss, bleeding gums and nose bleeds, increased sensitivity to the sun, peeling fingertips and nail changes, joint and muscle pain, decreased night vision, depression, and headaches. Isotretinoin and acitretin are both toxic to developing babies. Women on these medications need to avoid pregnancy by using two forms of birth control. Contraception is necessary before and after treatment (1 month for isotretinoin, 3 years for acitretin) to ensure full elimination of the drug from the body.
Points to remember
It is important to take the retinoid as directed and have regular blood tests. You should notify your doctor if you get headaches. If you are pregnant or are considering having a child, discuss this with your doctor before starting this medication. The use of two forms of effective birth control is important as long as you take this medication and for months to years after it is stopped. Breast-feeding should be avoided while taking retinoids because the drug can enter breast milk.
Drug interactions
Avoid dietary supplements with vitamin A. Acitretin can reduce the effectiveness of phenytoin, a common drug for epilepsy, when given at the same time. Oral retinoids should not be combined with tetracycline antibiotics, since both medications can cause increased pressure on the brain, which can have serious consequences.
Information to discuss with your primary care physician and other specialists
Be sure to notify your other physicians that you are taking this drug. Women taking this medication should discuss appropriate forms of birth control with their primary care physicians or gynecologists.
For more information
The Rheumatologic Dermatology Society (RDS) has compiled this list to give you a starting point for your own additional research. The RDS does not endorse or maintain these websites, and is not responsible for any information or claims provided on them. It is always best to talk with your dermatologist for more information and before making any decisions about your care.
National Institutes of Health: Medline Plus
Mayo Clinic Information on Acetretin
Medscape Reference-Isotretinoin