Neotigason (Acitretin)

Acitretin is a retinoid that modulates keratinocyte differentiation in keratinization disorders.

• Severe plaque psoriasis: reduces scaling and erythema by normalising skin cell turnover.
• Refractory psoriasis: provides an alternative when topical agents and other systemic drugs are ineffective.
• Congenital ichthyosis: improves skin barrier function and decreases hyperkeratosis in inherited ichthyotic conditions.

• Acitretin binds to nuclear retinoic acid receptors (RARs) and retinoid X receptors (RXRs) in keratinocytes, altering gene transcription that controls cell differentiation and proliferation. This regulation leads to reduced epidermal hyperplasia and normalises keratinisation. The drug also exerts anti‑inflammatory effects by modulating cytokine production, contributing to clinical improvement in psoriasis and ichthyosis.

Acitretin may cause a range of adverse reactions, from mild to serious. Monitoring and patient education are essential.

Common Side Effects

• Dry skin: increased transepidermal water loss causing roughness.
• Cheilitis: inflammation and cracking of the lips.
• Elevated triglycerides: lipid profile changes requiring periodic testing.
• Hair loss: temporary alopecia in some patients.
• Headache: mild to moderate intensity.
• Xerosis of mucous membranes: dryness of eyes and nasal passages.

Serious or Rare Side Effects

• Hepatotoxicity: liver enzyme elevations that may progress to liver injury.
• Severe hyperlipidaemia: marked increase in cholesterol or triglycerides.
• Pseudotumor cerebri: raised intracranial pressure presenting with headache and visual changes.
• Depression or mood disorders: psychiatric symptoms requiring prompt evaluation.
• Bone toxicity: premature epiphyseal closure in children.
• Severe cutaneous reactions: Stevens‑Johnson syndrome or toxic epidermal necrolysis.

Before initiating therapy, clinicians should assess patient history and conduct baseline laboratory tests.

• Pregnancy contraindication: teratogenic risk mandates strict contraception for women of child‑bearing potential.
• Liver monitoring: perform hepatic function tests regularly.
• Lipid monitoring: check fasting lipid profile before and during treatment.
• Vitamin A supplementation: avoid concurrent use to prevent excess retinoid toxicity.
• Store at ambient temperature: keep in the original container, protect from moisture and direct sunlight.

Acitretin can alter the efficacy or safety of several co‑administered medicines.

Major Interactions (Avoid)

• Tetracyclines: increased risk of intracranial hypertension.
• Vitamin A supplements: additive teratogenic and toxicity effects.
• Oral contraceptives: reduced effectiveness, heightening pregnancy risk.

Moderate Interactions (Monitor Closely)

• Cholestyramine or colestipol: may decrease acitretin absorption, adjust timing of doses.
• Warfarin: potential enhancement of anticoagulant effect, monitor INR.
• Systemic corticosteroids: may increase risk of pseudotumor cerebri.
• Lipid‑lowering agents: monitor lipid levels for additive changes.