Neotigason (Acitretin)

Neotigason, a systemic retinoid, is employed in dermatologic disorders that involve abnormal keratinization.

• Severe plaque psoriasis: reduces scaling, erythema and plaque thickness by normalising keratinocyte differentiation.
• Pustular psoriasis: controls widespread pustular eruptions through anti‑inflammatory and keratinisation‑modulating effects.
• Ichthyosis: improves skin barrier function and reduces hyperkeratosis by restoring normal epidermal cell turnover.

• Acitretin is a synthetic aromatic retinoid that binds to nuclear retinoic acid receptors (RARs) and retinoid X receptors (RXRs). Activation of these receptors modulates gene expression involved in epidermal cell differentiation and proliferation, leading to normalised keratinisation and anti‑inflammatory effects in the skin.

Acitretin may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Dry skin: increased epidermal dryness and scaling.
• Cheilitis: inflammation and cracking of the lips.
• Hair loss: temporary thinning of scalp hair.
• Elevated liver enzymes: mild transaminase rise detected on routine labs.
• Hyperlipidaemia: increase in serum triglycerides and cholesterol.
• Headache: mild to moderate cephalic discomfort.

Serious or Rare Side Effects

• Severe hepatic toxicity: jaundice or hepatic failure requiring discontinuation.
• Pancreatitis: acute abdominal pain with elevated pancreatic enzymes.
• Depression or mood changes: new‑onset depressive symptoms.
• Severe hypertriglyceridaemia: risk of pancreatitis.
• Teratogenicity: congenital malformations if exposure occurs during pregnancy.
• Bone changes: premature epiphyseal closure in adolescents.

Before initiating therapy, clinicians should assess several safety parameters and counsel patients on risk mitigation.

• Pregnancy contraindication: avoid use in women of child‑bearing potential; effective contraception required for at least 3 years after discontinuation.
• Liver function monitoring: obtain baseline and periodic liver enzyme tests.
• Lipid profile monitoring: check fasting triglycerides and cholesterol before and during treatment.
• Concomitant vitamin A: avoid combined use to prevent excess retinoid toxicity.
• Severe hyperlipidaemia: contraindicated in patients with uncontrolled lipid disorders.
• Store at ambient temperature: keep in the original pack, protect from moisture and light.

Acitretin can interact with several medicines, altering efficacy or safety.

Major Interactions (Avoid)

• Tetracyclines: increased risk of intracranial hypertension.
• Systemic vitamin A: additive teratogenic and toxicity risk.
• Cholestyramine or colestipol: reduces acitretin absorption, decreasing effectiveness.
• Oral contraceptives: may reduce contraceptive efficacy, increasing teratogenic risk.
• Warfarin: potential alteration of INR and bleeding risk.

Moderate Interactions (Monitor Closely)

• Methotrexate: additive hepatotoxicity; monitor liver enzymes.
• Statins: possible exacerbation of lipid abnormalities.
• Corticosteroids: enhanced anti‑inflammatory effects; watch for signs of excess.
• Phototherapy: increased photosensitivity; advise sun protection.
• Diuretics: may raise serum uric acid levels, risking gout.