Acitretin: What it treats and the safety steps you must know

Acitretin is an oral retinoid most often used for severe psoriasis and some keratinization disorders. It slows abnormal skin cell growth and can reduce scaling and thickness over weeks to months. Doctors choose acitretin when creams or light therapy aren’t enough or when large skin areas are involved.

Typical starting doses are low — often 10–25 mg daily — and can go up to 50 mg depending on how you respond and side effects. Your prescriber adjusts the dose for weight, other meds, and lab results. Take acitretin with food to help it absorb. If you miss one dose, skip it and take the next dose at the usual time; don’t double up.

Common side effects and monitoring

Expect dry lips and skin; cheilitis is very common and usually managed with simple moisturizers. Other mild effects include hair thinning, peeling, and brittle nails. More serious concerns are raised liver enzymes and higher cholesterol or triglycerides. Your care team will run baseline blood tests, then repeat liver and lipid panels regularly — often monthly at first, then every few months.

Avoid combining acitretin with other systemic retinoids or high-dose vitamin A. Tell your doctor about all medicines and supplements you take because interactions can raise risks, especially with drugs that affect the liver.

Pregnancy, alcohol, and long-term safety rules

Acitretin is highly teratogenic — it can cause severe birth defects. Women who can become pregnant must use reliable contraception before starting, during treatment, and for three years after stopping. Pregnancy tests are required before and during therapy. Do not donate blood while on acitretin and for three years after stopping.

Do not drink alcohol while taking acitretin. Alcohol can convert acitretin into etretinate, a compound that stays in fat tissue for much longer and extends the period of risk. Because of that conversion, the three-year pregnancy rule exists. If you drink alcohol, tell your doctor — they may recommend a different treatment.

If you notice severe symptoms such as jaundice, severe abdominal pain, sudden mood changes, or signs of pancreatitis (intense upper belly pain, nausea, vomiting), seek medical help right away. Mild side effects often ease with time or a lower dose.

Before you start, ask your clinician about expected timelines, contraception, lab checks, and alternative options. Acitretin works slowly and often in combination with topical care or light therapy. Keep notes on your skin, labs, and side effects so you and your doctor can decide the best next steps.