Retinoids for psoriasis

Examples

Topical medicines (gel, cream, or ointment)

Generic Name	Brand Name
tazarotene	Tazorac

Oral medicines (pills or capsules)

Generic Name	Brand Name
acitretin	Soriatane
isotretinoin	Accutane

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

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

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

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

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

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.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Author:	Douglas Dana Maria G. Essig, MS, ELS	Last Updated: February 15, 2008
Medical Review:	Anne C. Poinier, MD - Internal Medicine Kathleen Romito, MD - Family Medicine Alexander H. Murray, MD, FRCPC - Dermatology
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