Acitretin: What It Is, How It Works, and What You Need to Know

When your skin won’t respond to creams or light therapy, acitretin, a synthetic retinoid derived from vitamin A used to treat severe psoriasis and other skin disorders. Also known as Soriatane, it works by slowing down the overgrowth of skin cells that cause thick, scaly patches. Unlike topical treatments, acitretin is taken orally and affects your whole body, making it one of the most potent tools doctors have for stubborn cases.

It’s not a first-line drug — you won’t start here unless your psoriasis is severe, or you’ve tried other options without success. But when it works, it works well. Studies show it can clear up 70% or more of plaque psoriasis in patients who stick with it. It’s also used for pustular psoriasis, severe eczema, and even rare conditions like ichthyosis. What makes acitretin different from other retinoids is how long it stays in your system — it can linger for months after you stop taking it, which is why women of childbearing age need to avoid pregnancy for at least three years after the last dose. That’s not a suggestion. It’s a hard rule backed by real cases of birth defects.

Side effects are common but manageable. Dry lips, cracked skin, nosebleeds, and joint stiffness show up in most users. Your doctor will monitor your liver and cholesterol levels because acitretin can raise both. You’ll need blood tests every few months. Alcohol is a big no — mixing it with acitretin turns the drug into a longer-lasting, more dangerous version that stays in your body for years. That’s why some patients are switched to isotretinoin instead, which doesn’t have this interaction. But if you’re looking for long-term control without constant injections or biologics, acitretin is still a go-to.

It’s not just about the drug — it’s about how you use it. Many people stop because their skin clears up and they think they’re done. But stopping too soon can mean a rebound flare, sometimes worse than before. That’s why doctors often pair acitretin with other treatments like methotrexate or phototherapy to get better results and lower the dose needed. It’s a team effort. And while it’s not cheap, generic versions are available and often covered by insurance if you’ve tried the usual options first.

People who’ve used acitretin often say the hardest part isn’t the side effects — it’s the patience. Results take weeks. Improvement isn’t overnight. But for those who’ve lived with flaking, itching skin for years, the payoff is real. You’ll find posts here that break down how to manage dryness, what to expect during treatment, how to talk to your doctor about alternatives, and even how some patients combine it with lifestyle changes to reduce the dose they need. Whether you’re just starting out or have been on it for months, this collection gives you the straight talk you won’t get from a brochure.