What are the side effects of acitretin?

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What are the side effects of acitretin?

Acitretin is an oral retinoid, primarily used to treat severe psoriasis and other keratinization disorders. While it can be effective in managing these conditions, it is associated with a range of potential side effects due to its systemic action on the body. Here is a detailed overview of the side effects of acitretin:

Common Side Effects

Skin and Mucous Membranes
- Dry Skin and Lips (Cheilitis):
  - Dryness, peeling, and cracking of the skin and lips are very common.
  - Lip balms and moisturizers can help manage these symptoms.
- Skin Peeling and Scaling:
  - The skin may become dry, flaky, and start peeling, especially on the palms and soles.
- Nail Changes:
  - Brittle nails, nail fragility, and changes in nail texture and color.
- Hair Changes:
  - Thinning hair or temporary hair loss (alopecia) can occur.
Mucous Membranes
- Dry Mouth and Nose:
  - Dryness of the oral and nasal mucosa, leading to nosebleeds and dry mouth.
- Conjunctivitis:
  - Dry eyes and conjunctivitis (inflammation of the eye’s conjunctiva) are common, sometimes requiring the use of artificial tears or other eye lubricants.
Musculoskeletal System
- Joint and Muscle Pain:
  - Arthralgia (joint pain) and myalgia (muscle pain) are relatively common.
- Back Pain:
  - Some patients may experience back pain.
- Skeletal Changes:
  - Long-term use can lead to skeletal hyperostosis (excessive bone growth), particularly in the spine, and can cause joint stiffness and decreased mobility.
Liver Function
- Elevated Liver Enzymes:
  - Acitretin can cause an increase in liver enzymes (ALT, AST), indicating liver stress or damage. Regular monitoring of liver function tests is necessary.
- Hepatitis:
  - Rarely, acitretin can cause hepatitis, which requires discontinuation of the drug.
Lipid Metabolism
- Hyperlipidemia:
  - Acitretin can elevate blood lipid levels, including cholesterol and triglycerides. This increases the risk of cardiovascular issues.
- Pancreatitis:
  - Severe hypertriglyceridemia can lead to pancreatitis, which is a medical emergency.
Gastrointestinal System
- Abdominal Pain:
  - Some patients experience abdominal discomfort or pain.
- Nausea and Vomiting:
  - These symptoms can occur, particularly when starting the medication.
- Dry Lips and Mouth:
  - Dryness can affect the mouth and lips, leading to discomfort and potential difficulty eating.
Central Nervous System
- Headaches:
  - Headaches, including migraines, are reported in some patients.
- Mood Changes:
  - Depression and mood swings can occur, although these are less common.
Reproductive System and Teratogenicity
- Teratogenicity:
  - Acitretin is highly teratogenic, meaning it can cause severe birth defects. It is crucial for women of childbearing age to avoid pregnancy during treatment and for at least three years after discontinuation.
  - Effective contraception is mandatory for women of childbearing potential.
- Menstrual Irregularities:
  - Some women may experience changes in their menstrual cycle.

Less Common Side Effects

Photosensitivity
- Increased sensitivity to sunlight can occur, leading to a higher risk of sunburn. Patients are advised to use sun protection and avoid excessive sun exposure.
Bone Changes
- Long-term use can lead to changes in bone density and structure, potentially resulting in osteoporosis or osteosclerosis (abnormal hardening of bone).
Peripheral Neuropathy
- Rarely, patients may develop peripheral neuropathy, characterized by numbness, tingling, or pain in the extremities.
Vision Changes
- Night blindness (nyctalopia) and other visual disturbances have been reported. Regular eye exams are recommended.
Ear Disorders
- Tinnitus (ringing in the ears) and hearing impairment can occur in rare cases.

Monitoring and Management

Regular Monitoring:
- Liver Function Tests: Regular blood tests to monitor liver enzymes are essential.
- Lipid Profile: Monitoring of cholesterol and triglyceride levels.
- Pregnancy Tests: For women of childbearing potential, regular pregnancy tests are necessary to ensure no pregnancy occurs during and after treatment.
Supportive Care:
- Moisturizers and Lip Balms: To manage dry skin and lips.
- Artificial Tears: For dry eyes.
- Sun Protection: Use of sunscreen and protective clothing to prevent photosensitivity reactions.
Lifestyle Adjustments:
- Diet: A low-fat diet may help manage hyperlipidemia.
- Exercise: Regular physical activity to maintain overall health, though caution with high-impact activities due to joint pain.

Conclusion

Acitretin is an effective treatment for severe psoriasis and other skin disorders but comes with a wide range of potential side effects due to its systemic action. These side effects can affect various organs and systems, necessitating regular monitoring and supportive care to manage them effectively. Patients should work closely with their healthcare providers to balance the benefits of treatment with the management of side effects, ensuring the best possible outcomes.