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Your Guide to Retinoids for Psoriasis

Posted on May 03, 2022
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Maureen McNulty

Retinoids are often used to treat psoriasis, a skin condition that causes inflammation and leads to itchy or scaly patches. Although there’s no cure for psoriasis, treatments like retinoids can help reduce symptoms and manage flares.

What Are Retinoids?

Retinoids are a laboratory-made form of vitamin A. Vitamin A has many important roles within the body. It helps support the health of the skin, eyes, bones, and other tissues, and affects how cells grow and divide. It also acts as an antioxidant, protecting cells from damage.

How Do Retinoids Work?

For people with psoriasis, retinoids help correct some of the processes that go wrong in the skin. In particular, it helps control a process known as skin turnover, or renewal of the skin. Stem cells in a deep layer of the skin continually produce new skin cells that gradually move toward the skin’s surface, and eventually die. Dead and damaged skin cells are shed, and new cells are produced to take their place.

Normally, this process takes a long time — about 50 days. However, in people with psoriasis, it occurs too quickly. New skin cells are produced at rapid rates, and skin cells build up more quickly than they are shed, forming lesions. The whole skin turnover process only takes about five days for someone with psoriasis.

Retinoids help control how skin cells grow, divide, and die. In people with psoriasis, they can slow down skin growth and reduce inflammation.

These medications treat several of the symptoms of psoriasis. They can lessen scaling and reduce the thickness of the skin. They can also improve nail symptoms and help fingernails and toenails grow more normally.

Although retinoids are related to vitamin A, these medications work differently than over-the-counter products that sometimes contain vitamin A, such as vitamin supplements and skin serums or moisturizers. These other products aren’t a substitute for retinoid medications that you get from a doctor.

Types of Retinoids for Psoriasis

There are two retinoid medications that may be given to treat this condition. Retinoids may be topical (applied directly to the skin) or oral (taken by mouth). Oral retinoids may also be referred to as “systemic,” because they travel throughout the body. Doctors typically prescribe oral retinoids when someone’s psoriasis covers a large portion of their body.

Topical Retinoids for Psoriasis

Tazarotene (Tazorac) is a topical retinoid. It can help treat abnormal skin patches in people with mild or moderate psoriasis. Tazarotene most often causes psoriasis symptoms to decrease by about 50 percent, although occasionally it can help lesions completely clear away. Even though symptoms disappear, they will usually come back within three months.

Tazarotene comes in different strengths and forms, such as a gel or cream. It needs to be applied once or twice per day, according to a doctor’s instructions. Doctors don’t prescribe tazarotene to those who are pregnant, as it may harm a fetus. (The National Library of Medicine states that you should get multiple negative pregnancy test results in the two weeks before using tazarotene. It also suggests first using it amidst a menstruation period for insurance.)

Dermatologists may recommend using tazarotene in combination with a topical corticosteroid. Using both medications together may improve treatment effectiveness, help psoriasis symptoms stay away for longer periods before returning, and prevent side effects. The combination works because tazarotene helps the steroid penetrate the skin, which makes it more effective in stopping inflammation. In fact, the FDA approved one prescription medication (Duobrii) in 2019 that contains both tazarotene and a steroid. Topical treatments like tazarotene can also be used along with phototherapy (light therapy).

When using tazarotene, the skin may temporarily look worse before it gets better. Psoriasis lesions may first get intensely red, and then disappear.

Oral Retinoids for Psoriasis

Acitretin (Soriatane) is generally only used for very severe or widespread psoriasis. A doctor may recommend this medication for people who are hospitalized with psoriasis that doesn’t respond to other treatments. Because it doesn’t affect the joint condition psoriatic arthritis, it is not prescribed if that symptom occurs alongside skin inflammation.

Acitretin may be given to treat multiple types of psoriasis, including guttate, pustular, erythrodermic, or plaque psoriasis. It may also be a good choice for people with compromised immune systems, such as those who are HIV-positive, because acitretin doesn’t weaken the immune system.

Acitretin is a capsule that is usually taken once each day. Doctors usually recommend taking this drug along with a meal. This medication comes in two different doses — 10 mg or 25 mg. Your doctor may switch you to a lower dose as your symptoms improve, and then have you stop taking it altogether if your psoriasis plaques are mostly gone.

Acitretin may be combined with other psoriasis treatments like etanercept (Enbrel), infliximab (Remicade), methotrexate, or cyclosporine. It also may be more effective when it is used alongside phototherapy.

As with tazarotene, psoriasis symptoms may worsen before they improve when taking acitretin. This medication tends to work more slowly than other psoriasis treatment options. You may not start to feel better until two months after you begin taking it. In some cases, major improvement may not occur until six months later.

Common Side Effects of Retinoids

Tazarotene can help prevent the abnormal skin growth that occurs in psoriasis lesions. However, in skin that is already functioning normally, it can interrupt growth processes and cause irritation, redness, and peeling. To prevent those problems, you may try spreading petroleum jelly (such as Vaseline) over the surrounding area before applying tazarotene.

Tazarotene also makes skin more sensitive to light. If you use this medication, ask your doctor what precautions you may need to take, such as using sunscreen or wearing clothes that cover the skin where you are applying the drug.

Other side effects of tazarotene may include a feeling of itching, burning, or stinging. Tell your doctor if you notice these sensations.

Tazarotene primarily stays in the skin once it’s applied — very little of this drug ends up in other parts of the body. Therefore, tazarotene has fewer side effects than acitretin, which travels around the body and reaches many different types of tissues.

Acitretin may lead to several side effects, including:

  • Skin irritation or dryness
  • Chapped lips
  • Dry eyes
  • Increased risk of sunburn
  • Muscle and joint soreness
  • Headache
  • Hair loss
  • Bleeding problems, such as nose bleeds
  • Decreased night vision
  • Depression
  • Thoughts of self-harm

Precautions While Using Retinoids

Tell your doctor about any medications or supplements before using retinoids. While using these medications, don’t take other supplements that have vitamin A. You should also avoid taking the antibiotic tetracycline.

Retinoids can harm a developing baby and lead to birth defects, so they aren’t given during pregnancy. People who take topical or oral retinoids should use birth control while they are using the drug. Retinoids should also be avoided while breastfeeding.

Additionally, acitretin stays in the body for a long time after it is taken. For this reason, acitretin is usually not recommended if there is a chance a person is or could become pregnant. Pre-treatment precautions include getting two negative results on pregnancy tests. Furthermore, the National Library of Medicine notes it’s critical to use two forms of birth control in the month before taking acitretin, while you use acitrin, and for at least three years after you stop using it.

Because acitretin remains present in your blood after using it, you should also avoid donating blood while using this treatment. Don’t start giving blood again until at least three years have passed.

Acitretin may not be a good choice for people who have liver disease, kidney problems, or high triglycerides (elevated levels of fat in the blood). Blood work is checked before and during treatment to avoid any conflicts. If you have a history of any of these conditions, definitely tell your doctor before you use retinoids.

Talk With Others Who Understand

On MyPsoriasisTeam, the social network for people with psoriasis and their loved ones, more than 107,000 members come together to ask questions, give advice, and share their stories with others who understand life with the condition.

Have you used retinoids to treat your psoriasis? Share your experience in the comments below, or start a conversation by posting on MyPsoriasisTeam.

All updates must be accompanied by text or a picture.
Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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