Acitretin: Brands, Price & Uses in Bangladesh

Established / Approved Use

• Severe psoriasis: Acitretin is indicated for the treatment of severe, extensive psoriasis in adults, including plaque, pustular (including generalized/palmo-plantar pustular psoriasis), and erythrodermic forms that are resistant to other systemic therapies or topical treatment.

Guideline-Supported / Adjunct Uses

• Used as monotherapy or in combination with phototherapy (Re-PUVA) for extensive plaque or pustular psoriasis, which can allow lower doses of both agents.
• Maintenance therapy in chronic, relapsing psoriasis under specialist (dermatologist) supervision.

Off-Label / Other Disorders of Keratinization (commonly used, evidence-based but outside the core psoriasis label)

• Severe congenital ichthyoses (e.g., lamellar ichthyosis, congenital ichthyosiform erythroderma).
• Darier's disease (keratosis follicularis).
• Other severe disorders of keratinization such as palmoplantar keratoderma, pityriasis rubra pilaris, and lichen planus (in refractory cases), when prescribed by a specialist.

Note: Acitretin must only be prescribed by, or under the supervision of, a physician experienced in the use of systemic retinoids, because of its serious teratogenic risk (see Contraindications and Pregnancy & Lactation).

Adult Dosing — Psoriasis

Darier's Disease and Severe Ichthyoses

Lower starting doses (around 10 mg/day) are typically used, with cautious, gradual increases based on response and tolerability, under specialist supervision.

Pediatric Dosing (specialist use only, off-label conditions)

When used for severe, disabling disorders of keratinization in children under specialist care, dosing is weight-based, approximately 0.5 mg/kg/day, not exceeding the maximum adult dose. Acitretin is not approved for pediatric psoriasis in most regulatory labels; see Use in Special Populations.

Administration

Acitretin capsules should be swallowed whole with a meal or with milk to enhance absorption; do not crush or chew. Take at the same time each day.

Duration

Initial response is usually assessed over 2–4 weeks, with continued treatment for 6–8 weeks or longer as needed; total duration and need for repeat/maintenance courses should be determined by the treating dermatologist. See Duration of Treatment.

Very Common (largely dose-related, mucocutaneous)

• Cheilitis (dry, cracked lips) — occurs in the majority of patients
• Dry skin, skin peeling (especially palms and soles), and dry mucous membranes
• Dry, irritated eyes; reduced tolerance to contact lenses
• Dry nasal mucosa, occasional nosebleeds
• Hair thinning/alopecia (usually reversible after stopping treatment)
• Pruritus (itching)

Common

• Elevated blood triglycerides and/or cholesterol
• Elevated liver enzymes
• Paronychia (nail fold inflammation), nail fragility
• Increased sun sensitivity (photosensitivity)
• Joint or muscle aches

Uncommon/Rare but Serious

• Pseudotumor cerebri (benign intracranial hypertension) — severe headache, nausea, visual changes; seek urgent care
• Skeletal changes (hyperostosis) with long-term use
• Night blindness (impaired dark adaptation)
• Mood changes, depression (rare; monitor and report promptly)
• Severe hepatotoxicity (rare)

Patients should report severe headache, visual disturbance, mood changes, or yellowing of the skin/eyes promptly to their physician.