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Soriatane (acitretin) is a retinoid use to treat severe psoriasis that has not responded well to other treatments, or other treatments cannot be taken. The medication slows cell division, influencing the way in which skin cells grow and shed, though its exact mechanism in helping with psoriasis is unclear.

Off-label Soriatane may be used to treat other severe skin conditions that have not responded to other treatments. While treatment is more or less the same in all cases, whether or not Soriatane will provide benefit is less clear; some patients respond well while others do not, even when the condition being treated is seemingly the same. Conditions which typically do respond well include Darier's disease, palmoplantar pustulosis, lichen planus, and Sjogren-Larsson syndrome.

Getting Started with Soriatane

Soriatane is administered by tablets, which are only available in 10 mg and 25 mg strengths. The standard dose in all cases is 25 mg to 50 mg per day, once per day, taken with a meal. Patients typically take higher doses at the start of treatment until the condition is being controlled, after which dosage may drop to 10 mg or 25 mg over the longer term. Some patients do stay at 50 mg per day, however. 75 mg per day should not be exceeded.

Duration of treatment can be variable. Soriatane is a potent medication which can produce a number of severe side effects, so the shortest treatment time as possible is desirable. It takes several weeks for the medication to work, however, with most patients seeing improvement after 8 to 16 weeks of treatment; dosage may then be reduced somewhat. The condition should continue to improve for 6 months, after which time the need for continued treatment should be regularly assessed.

In the first 8 to 16 weeks the condition may worsen, sometimes considerably. This can be very stressful for patients, physically and mentally. The worsening of the condition means the medication is working, however, and it should start to clear up within 3 months. The payoff is usually worth it.

Patients who stop taking Soriatane will typically stay free of lesions for several years, after which time the condition will likely return. Treatment can then be repeated.

For psoriasis, Soriatane is most effective when used with phototherapy. If an adjustment must be made, it's best that phototherapy is adjusted downward. Other medications, such as etanercept or infliximab, may also be used during treatment.

Soriatane, Pregnancy, and Blood Donation

Soriatane is known to cause serious birth defects. Women who are pregnant or breastfeeding should not take it at all. Women of childbearing age may need to jump through some hoops to get this medication; many doctors require at a minimum two negative pregnancy tests and proof that a woman is willing to utilize two forms of birth control, and progesterone-based birth control cannot be one of them as Soriatane can interfere with its effectiveness.

The medication may stay in the body for up to three years after treatment ends; women are advised to use two non-progesterone birth control methods for that time as well.

Soriatane is also present in sperm, though whether or not it is present in amounts sufficient to cause birth defects is unclear. Men taking Soriatane may want to avoid impregnating a woman for the duration of treatment and for the following three years.

Both men and women should avoid donating blood for three years after completing Soriatane treatment. The medication can cause a number of severe side effects in patients who unknowingly receive it.

Other Side Effects

Soriatane can produce a number of other side effects:

• Elevated liver enzymes
• Changes in blood fat levels
• Hair loss
• Joint pain
• Decreased night vision
• Bleeding gums
• Nosebleeds
• Increased light sensitivity
• Aggression
• Self-harm
• Depression
• Finger- and toenail changes
• Dry skin
• Dry eyes

The above symptoms are generally not cause for concern unless severe. If side effects do become worrisome do not hesitate to contact a doctor. Side effects will reverse once treatment ends.

Other medications can also interact with Soriatane, some of which mean the medication should not be taken at all:

• Tetracycline
• Doxycycline
• Demeclocycline
• Minocycline
• Methotrexate

Additional medications can interfere with Soriatane, but do not necessarily mean it cannot be used. Check with a doctor or pharmacist before taking any other medication for the duration of treatment.