Acitretin
Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
Acitretin is a second-generation systemic retinoid (active metabolite of etretinate) used for the treatment of severe psoriasis (including plaque, pustular, and erythrodermic types) that is unresponsive to conventional therapy. It is also used off-label for other keratinization disorders including lichen planus, pityriasis rubra pilaris, and ichthyosis. Unlike isotretinoin, acitretin does not significantly affect sebaceous gland function and is not used for acne.
Exploratory record, not a reviewed medical publication.
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What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
Acitretin is a second-generation systemic retinoid (active metabolite of etretinate) used for the treatment of severe psoriasis (including plaque, pustular, and erythrodermic types) that is unresponsive to conventional therapy. NutriStack rates the supporting evidence as strong. Common adult dosing is 25-50 mg/day with the main meal; start at 25 mg/day and adjust based on response and tolerability (as prescribed by your physician), though a prescriber sets the actual dose. This profile indexes 10 sources.
- Cheilitis (dry, cracked lips, dose-dependent, nearly universal)
- Alopecia (hair thinning/loss)
- Dry skin and pruritus
- Pregnancy, must not conceive for at least 3 years after discontinuation (teratogen; converted to etretinate with alcohol)
- Breastfeeding
The bottom line
Evidence rating strong. Most-documented uses: effective for severe plaque, pustular, and erythrodermic psoriasis, enhances efficacy of phototherapy (puva, uvb) when combined, useful for disorders of keratinization. 10 sources indexed (1989–2024), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
Binds to retinoic acid receptors (RAR) and retinoid X receptors (RXR), modulating gene expression involved in cell proliferation, differentiation, and keratinization. In psoriasis, it normalizes the accelerated epidermal proliferation, reduces keratinocyte hyperproliferation, and has anti-inflammatory and immunomodulatory effects. It inhibits IL-6, reduces neutrophil chemotaxis, and modulates T-cell function.
Dosing & protocol.
Absorption is enhanced when taken with food, especially a fatty meal. Oral bioavailability ~60%. Important: if combined with alcohol, acitretin is converted to etretinate, which has an extremely long half-life (120 days), prolonging teratogenic risk.
Full safety detail.
Side effects
- Cheilitis (dry, cracked lips, dose-dependent, nearly universal)
- Alopecia (hair thinning/loss)
- Dry skin and pruritus
- Elevated triglycerides and cholesterol
- Elevated liver enzymes (hepatotoxicity)
- Musculoskeletal symptoms (arthralgias, myalgias)
- Sticky skin and peeling of palms/soles
- Skeletal hyperostosis (with long-term use)
Contraindications
- Pregnancy, must not conceive for at least 3 years after discontinuation (teratogen; converted to etretinate with alcohol)
- Breastfeeding
- Severely impaired liver or kidney function
- Chronic hyperlipidemia
- Concomitant use with methotrexate (increased hepatotoxicity risk)
- Concomitant use with tetracyclines (pseudotumor cerebri risk)
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Meta-analyses & systematic reviews
3- 1Xiyanping injection combined with acitretin for psoriasis vulgaris: A systematic review and meta-analysisPMIDWu MN, Zhou LJ, Zhou DM · Frontiers in pharmacology · 2022
Wu MN, Zhou LJ, Zhou DM. Xiyanping injection combined with acitretin for psoriasis vulgaris: A systematic review and meta-analysis. Frontiers in pharmacology. 2022
- 2A Meta-analysis of Xiaoyin Granules Combined with Acitretin Capsule in the Treatment of Psoriasis VulgarisPMIDGeng A, Pei T, Zhao X et al. · Computational and mathematical methods in medicine · 2022
Geng A, Pei T, Zhao X et al.. A Meta-analysis of Xiaoyin Granules Combined with Acitretin Capsule in the Treatment of Psoriasis Vulgaris. Computational and mathematical methods in medicine. 2022
- 3Acitretin-induced periungual pyogenic granulomas and reviewPMIDThomas M, Shon W, Truong AK · Dermatology online journal · 2021
Thomas M, Shon W, Truong AK. Acitretin-induced periungual pyogenic granulomas and review. Dermatology online journal. 2021
Randomized controlled trials
1- 4A double-blind, placebo-controlled trial of acitretin for the treatment of psoriasisPMIDOlsen EA, Weed WW, Meyer CJ et al. · Journal of the American Academy of Dermatology · 1989
Olsen EA, Weed WW, Meyer CJ et al.. A double-blind, placebo-controlled trial of acitretin for the treatment of psoriasis. Journal of the American Academy of Dermatology. 1989
Reviews & position papers
1- 5A report on the safety of acitretin use in patients with renal failure on haemodialysisPMIDShim PJ, Quintos JL, Faraz K et al. · Clinical and experimental dermatology · 2024
Shim PJ, Quintos JL, Faraz K et al.. A report on the safety of acitretin use in patients with renal failure on haemodialysis. Clinical and experimental dermatology. 2024
Reference material
5- 6Katz HI et al. A multi-center, double-blind trial of acitretin in the treatment of severe psoriasis. J Am Acad Dermatol. 1999;41(2 Pt 1):311-314.Source linkedPMID
- 7Lebwohl M et al. Acitretin in combination with UVB or PUVA in the treatment of psoriasis. J Am Acad Dermatol. 2001;45(4):544-553.Source linkedPMID
- 8Ormerod AD et al. British Association of Dermatologists guidelines on the efficacy and use of acitretin in dermatology. Br J Dermatol. 2010;162(5):952-963.Source linkedPMID
- 9Zito PM, Patel P, Mazzoni T. Acitretin. 2026Source linkedPMID
- 10Sarkar R, Chugh S, Garg VK. Acitretin in dermatology. Indian journal of dermatology, venereology and leprology. 2013Source linkedPMID
Common questions.
Quick answers about Acitretin, drawn from the data on this page.
What is Acitretin?
Acitretin is a second-generation systemic retinoid (active metabolite of etretinate) used for the treatment of severe psoriasis (including plaque, pustular, and erythrodermic types) that is unresponsive to conventional therapy. It is also used off-label for other keratinization disorders including lichen planus, pityriasis rubra pilaris, and ichthyosis. Unlike isotretinoin, acitretin does not significantly affect sebaceous gland function and is not used for acne.
What is Acitretin used for?
Commonly cited benefits of Acitretin include: Effective for severe plaque, pustular, and erythrodermic psoriasis; Enhances efficacy of phototherapy (PUVA, UVB) when combined; Useful for disorders of keratinization; No immunosuppression (unlike biologics or methotrexate). NutriStack rates the overall evidence as strong.
What is a typical dose of Acitretin?
A typical adult dose of Acitretin is 25-50 mg/day with the main meal; start at 25 mg/day and adjust based on response and tolerability (as prescribed by your physician). The commonly recommended form is Oral capsule; take with main meal to optimize absorption. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Acitretin?
Reported side effects include cheilitis (dry, cracked lips, dose-dependent, nearly universal), alopecia (hair thinning/loss), dry skin and pruritus, elevated triglycerides and cholesterol, elevated liver enzymes (hepatotoxicity), musculoskeletal symptoms (arthralgias, myalgias). This is educational information; check with a healthcare professional before use.
How strong is the evidence for Acitretin?
NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
Acitretin in NutriStack.
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