Acitretin Use in Renal Disease and Infection

Renal Disease Considerations

The American Academy of Dermatology recommends that acitretin is contraindicated in patients with severely impaired renal function 1
The American Academy of Dermatology/National Psoriasis Foundation guidelines state that severely impaired liver or kidney function is an absolute contraindication for acitretin therapy 1, 2
The British Association of Dermatologists recommends avoiding acitretin therapy in moderate to severe renal impairment 3
Baseline renal function tests are required before initiating acitretin therapy, with ongoing monitoring every 3 months, as recommended by the American Academy of Dermatology 1, 2

The British Association of Dermatologists notes an increased incidence of vulvovaginitis due to Candida albicans during acitretin treatment 3, 4, 5
The American Academy of Dermatology states that acitretin does not cause significant immunosuppression, and there is no contraindication to using acitretin in patients with active infections 3, 6
The British Association of Dermatologists recommends that acitretin does not significantly affect wound healing and does not need to be stopped for routine surgery 3, 4, 5
The American Academy of Dermatology warns that acitretin and tetracyclines are contraindicated together due to the risk of pseudotumor cerebri (benign intracranial hypertension) 1, 2, 6

Acitretin fundamentally differs from other systemic psoriasis therapies because it lacks immunosuppressive properties, making it uniquely safe for continued use during active infections, as supported by the American Academy of Dermatology 7, 8

For patients on acitretin who develop an infection, the American Academy of Dermatology recommends treating the infection appropriately with antimicrobials as indicated, while continuing acitretin at the current dose 7
If a patient requires escalation to immunosuppressive therapy for inadequate psoriasis control, infection management becomes more complex and would follow the guidelines for immunosuppressive agents, such as holding therapy during serious infections, as per the American Academy of Dermatology 7