Soriatane

Psoriasis that creams have not settled

When psoriasis covers more skin than ointments can handle, acitretin is one of the oral options. Soriatane supplies it as a 10mg capsule, in packs of 30, 60, 90 and 120. It is a retinoid, a compound built around vitamin A, used for the harder patterns of the condition: plaque psoriasis, guttate psoriasis (small drop-shaped patches), pustular psoriasis (pus-filled bumps on the palms and soles) and erythrodermic psoriasis (redness over most of the body).

A slow start, and skin that may look worse first

Skin often looks worse before it looks better. Acitretin slows how fast skin cells are made and shed, though exactly how is not understood, and the change shows gradually: most people see clearing somewhere between two and four months in, and the full effect can take six. It holds psoriasis back rather than curing it, so the course stops once the skin has cleared, and a flare-up later means starting again.

Starting low, and taking it with dinner

Treatment begins on a small dose that goes up over the first weeks and comes down again once the skin improves. The capsule goes down with your biggest meal, because food in the stomach helps acitretin get absorbed, and a steady mealtime from day to day keeps the level even. Leave the capsules in their pack, dry and out of bright light.

Dry lips first, and the effects that matter more

Cracked lips and a dry mouth usually come first, with dry eyes and dry skin. Thinning hair, flaky fingertips, brittle nails, gums that bleed, nosebleeds and skin that burns more easily in the sun often follow. Most of these settle as the dose comes down or the course ends. Blood fats and liver enzymes can climb, which is what the blood tests during a course are checking; nausea, loss of appetite, pain under the right ribs, yellowing of the eyes or skin, or dark urine point to liver trouble. Mood can change too: low mood, aggression and thoughts of self-harm have been reported.

What acitretin does not mix with

Alcohol turns acitretin into a compound the body clears very slowly, so drinking is off the table from the first capsule until two months after the last one. Extra vitamin A, from a supplement, adds to the same unwanted effects. Tetracycline antibiotics are avoided with it because both can raise pressure inside the skull, and acitretin can make phenytoin, an epilepsy medicine, work less well. People with severe liver or kidney disease, or very high blood fats (triglycerides), do not use it.