Retinoids for psoriasis

Examples

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Pills and gels

Brand Name	Chemical Name
Soriatane	acitretin

Brand Name	Chemical Name
Sotret	isotretinoin

Brand Name	Chemical Name
Tazorac	tazarotene

Retinoid gels are usually applied once a day.

Retinoids may be combined at low doses with other treatments, such as psoralen and ultraviolet A light therapy (PUVA), steroid creams or ointments, ultraviolet B (UVB) light exposure, and tar products.

How It Works

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It is not well understood how these medications work to treat psoriasis.

Why It Is Used

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Retinoids should not be used by women who are pregnant or who may become pregnant. Talk to your doctor before taking retinoids.

Retinoids are used to treat erythroderma and pustular psoriasis. They may also be used to treat severe plaque psoriasis that is resistant to other therapies. As symptoms improve, the dose is reduced and other medications may be used for treatment.

How Well It Works

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Generally, these medications are not used alone. If used alone, it may take several months to see any improvement. The condition may even get worse during the first few weeks of therapy. Tazarotene can cause a severe local irritation if used alone; it is much less irritating to the skin if used with a corticosteroid. Studies have shown that tazarotene combined with a corticosteroid is effective in reducing symptoms, prolonging remission (period of no symptoms), and reducing the side effects that are expected when corticosteroids are used alone.¹

Acitretin and tazarotene can improve the outcome of PUVA and UVB phototherapy.^{2, 3}

Side Effects

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Side effects of retinoid pills include:

• Serious birth defects.
• High cholesterol.
• Liver damage.

Side effects of retinoid gels include:

• Skin irritation.
• Sensitivity to the sun.
• Inflammation of the lips.
• Dry skin and dry mucous membranes.
• Hair loss.
• Rashes.
• Thinning of skin and easy bruising.
• Infection of tissues around the nails.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Blood tests are needed while you are taking this drug.

Because of severe side effects, acitretin (Soriatane) should be prescribed only by doctors who are familiar with the use of this kind of medication, such as a dermatologist. Some health professionals believe there are too many risks in using this medication.

Women who are pregnant or may become pregnant should not take isotretinoin because of the risk of serious side effects such as miscarriage and birth defects. The FDA has announced that the companies that make isotretinoin have a program to register doctors who prescribe isotretinoin and the people who take it. The program is to ensure that people taking this drug understand the risk of birth defects, take precautions to avoid pregnancy, and know what to do if they become pregnant. If your doctor suggests that you take isotretinoin, you must be registered with iPLEDGE beginning March 1, 2006 in order to get the drug. You can get more information and register at www.ipledgeprogram.com or by telephone at 1-866-495-0654.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Lebwohl M (2000). Strategies to optimize efficacy, duration of remission, and safety in the treatment of plaque psoriasis by using tazarotene in combination with a corticosteroid. Journal of the American Academy of Dermatology, 43(2, Part 3): S43–S46.

2. Lebwohl M (2000). Advances in psoriasis therapy. Dermatologic Clinics, 18(1): 13–19.

3. Guenther L (2000). Tazarotene combination treatments in psoriasis. Journal of the American Academy of Dermatology, 43(2, Part 3): S36–S42.

Credits

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Author	Shannon Erstad, MBA/MPH
Author	Ralph Poore
Editor	Kathleen M. Ariss, MS
Associate Editor	Michele Cronen
Primary Medical Reviewer	Patrice Burgess, MD - Family Medicine
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Alexander H. Murray, MD, FRCPC - Dermatology
Last Updated	January 6, 2006