Neotigason (Acitretin)

• Acitretin is used to manage severe psoriasis and related keratinization disorders by normalizing epidermal cell growth.
• Severe plaque psoriasis: reduces scaling and erythema by slowing keratinocyte proliferation.
• Pustular psoriasis: helps control widespread pustule formation through anti‑proliferative effects.
• Erythrodermic psoriasis: alleviates extensive skin redness and scaling in life‑threatening cases.
• Disorders of keratinization: improves skin texture in conditions such as ichthyosis by regulating differentiation.

• Acitretin binds to nuclear retinoic acid receptors (RARα, RARβ, RARγ) and retinoid X receptors, modulating gene transcription that controls keratinocyte differentiation and proliferation. This receptor activation normalizes epidermal growth, reduces hyperkeratosis, and diminishes inflammatory cytokine production, leading to clinical improvement in psoriasis and keratinization disorders. The effect is dose‑dependent and contributes to restoration of normal skin architecture. It does not directly suppress the immune system, distinguishing it from many biologic agents.

Acitretin may cause a range of adverse reactions, which are categorized by frequency and severity.

Common Side Effects

• Dry skin and lips: noticeable xerosis and cheilitis.
• Elevated triglycerides: mild to moderate hypertriglyceridemia.
• Headache: transient tension‑type headaches.
• Nausea: occasional gastrointestinal discomfort.

Serious or Rare Side Effects

• Hepatotoxicity: significant elevation of liver enzymes.
• Severe hyperlipidemia: marked increase in cholesterol or triglycerides.
• Pseudotumor cerebri: intracranial hypertension presenting with headache and visual changes.

• When prescribing Acitretin, clinicians should observe several safety measures.
• Pregnancy: contraindicated due to high teratogenic risk (Category X).
• Women of childbearing potential: require effective contraception during treatment and for at least 3 years after discontinuation.
• Liver function: monitor hepatic enzymes before and during therapy.
• Lipid profile: assess triglycerides and cholesterol periodically.
• Skeletal health: avoid long‑term use in patients with pre‑existing bone disease; monitor for hyperostosis.
• Store at ambient temperature below 25°C: keep in the original container, protect from moisture and light.

Acitretin interacts with several medicines; awareness of interaction severity guides management.

Major Interactions (Avoid)

• Tetracyclines: increased risk of pseudotumor cerebri.
• Vitamin A supplements: additive retinoid toxicity.
• Estrogen‑containing therapies: heightened teratogenic potential.

Moderate Interactions (Monitor Closely)

• Methotrexate: may enhance hepatotoxicity.
• Cyclosporine: possible increased nephrotoxicity.
• Lipid‑lowering agents: may require adjustment of acitretin dosing.