Side Effects
Skin
- alopecia
- chapped lips
- dry mucus
- membranes
- pruritus
- peeling of eyelids, fingertips, palms and soles
- photosensitivity
Liver
- transient elevation of serum transaminases
- lactic dehydrogenase
Lipids
- elevated serum triglycerides
- elevated cholesterol
- decreased high-density lipoprotein
Bones/muscles
- arthralgia
- myalgia
- diffuse hyperostosis of the spine
- muscle stiffness
Ocular
- eye irritation
- blepharitis
- photophobia
- conjunctivitis
Other
- headaches
- nausea
- anemia
- leukemia
Minimizing Side Effects
- Many side effects of the skin are dose related, occurring within the first few days of therapy, and are reversible when treatment is terminated
- They also occur particularly with high initial doses during treatment and then after at least 2 years off-therapy (after a pregnancy)
- Liberal use of emollients and periodic use of corticosteroids can help with skin dryness
- Hair loss is a dose-related effect and is reversible within 2 months after discontinuing therapy or a significant dose reduction
- Hair loss and paronychia may occur with high initial doses of acitretin (greater than 50 mg/day)
Safety
- Not to be used by women who are, or intend to become, pregnant during treatment, and for two years following discontinuation of treatment (some of the literature says 3 years…)
- If a woman of childbearing age takes acitretin, she must use two forms of reliable birth control and have monthly pregnancy tests
- All food, drinks or medicines containing alcohol must be avoided during treatment and for at least two months after treatment is stopped
- Patients must not exceed the minimum recommended daily allowance of vitamin A due to additive toxic effects and increased risk of intracranial hypertension
