Retinoids for psoriasis

Examples

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Topical medicines (gel, cream, or ointment)

Brand Name	Generic Name
Tazorac	tazarotene

Oral medicines (pills or capsules)

Brand Name	Generic Name
Soriatane	acitretin

Brand Name	Generic Name
Sotret	isotretinoin

Retinoid gels are usually applied once a day. Retinoid pills are usually taken either every other day or every 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 retinoids work to treat psoriasis. They help slow the growth and shedding of skin cells.

Why It Is Used

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Retinoids are used to treat erythroderma and pustular psoriasis. Topical medicines that you spread on affected areas of the skin are used for mild to moderate psoriasis. Oral medicines that you take as pills or capsules are used to treat severe psoriasis that is resistant to other therapies. As symptoms improve, the dose may be reduced and other medicines may be used for treatment.

Retinoids should not be used by women who are pregnant or who are planning to become pregnant within 3 years after stopping retinoid treatment.¹ The medicines are teratogens, which means they can cause birth defects in a fetus.

How Well It Works

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Generally, these medicines 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 it is 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.²

Acitretin and tazarotene can improve the outcome of PUVA and UVB phototherapy.^{3 4}

Side Effects

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Topical retinoids are safer than oral retinoid medicines.

Side effects of retinoid gels include:

• Skin irritation and sensitivity to the sun.
• Dry skin and dry mucous membranes.
• Hair loss.
• Rashes.
• Thinning of skin and easy bruising.

Side effects of retinoid pills include:

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

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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You will need to have blood tests on a regular schedule 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 medicine.

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 U.S. Food and Drug Administration (FDA) requires companies that make isotretinoin to have a program to register doctors who prescribe isotretinoin and the people who take isotretinoin. The program tries to ensure that people taking this medicine 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 register with iPLEDGE to get the medicine. You can get more information and register at www.ipledgeprogram.com or by telephone (toll-free) 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. Menter A, Griffiths CEM (2007). Current and future management of psoriasis. Lancet, 370(9583): 272–284.

2. 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.

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

4. 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	Maria G. Essig, MS, ELS
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer	Alexander H. Murray, MD, FRCPC - Dermatology
Last Updated	December 10, 2007