At what point do you call Acitretin quits?

[PainInTheGuttate]

Ok so brief background, I've suffered with guttate (mainly on my back, legs and arms) for around 5 years and have been on various creams and had UVB twice. UVB has worked for me in the past however it just isn't feasible to take time off work 3 times a week to get the treatment. Also, I found that my P comes back within the matter of months once I've finished. 

So after speaking with my derm and reading a few posts on here I decided to give Acitretin a go. I started the treatment on 1 August but was only on 10mg to start and was working my way up to 35mg daily (so 10mg for 2 weeks, 25 mg 2 weeks then 35mg). I have now been on 35mg daily for 5 weeks and whilst the side effects have been minimal I have noticed little to no change in my P. On my 6 week check-up with my dorm he said to give it another 12 weeks to see if there is any change. 

I understand that Acitretin is a bit of a slow burner but apart from one patch on my leg I really haven't seen any difference, in fact, this week I think I am noticing a few new patches spring up. So I'm wandering at what point do I call it quits and say this isnt working for my P because surely I would have seen some results by now? 

If anyone has an experience of Acitretin taking this long (2 months) to show any signs of working it would be appreciated. 

Also, if I do move off Acitretin what's the logical next step? MTX is not an option for me to be fair, I'm 25 and the idea of not being able to drink just doesn't fit. I'm open to the idea of injections however, I don't think my P is severe enough to be able to get them through the NHS.

[jiml]

Hi it's a diffiçult one but to be honest I would give it longer,  as it's not a fast working drug from what I've read here and elsewhere, you've struggled for five years with the disease a few more weeks are worth waiting if the side effects aren't bad

Ok let's assume it doesn't work ( although I hope it will work) but if it doesn't  you have other oral alternatives like cyclosporine
Or  the drug I'm on Fumaderm  it's very good and has worked 6years for me
and the new DMF  drug similar to Fumaderm called Skilarence

Ciclosporine
Fumaderm
Skilarence

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[Fred]

Good question. I have never used Acitretin but I would like to post.

#1 At what point do you call it quits on any treatment? Answer when you are no longer happy with the results, or you feel it's just not for you.

#2 Good choice on keeping well away from poison Methotrexate.

#3 At the age of 25 I wouldn't go for the Bio treatments just yet.

Apart from that I have nothing else to add, hopefully some of our Acitretin users will have more.

[Maryam]

Besides cyclosporine, most systemic meds start to make a difference after 3 months. So I'd sit it out for a couple of weeks. Guttata is also more difficult to get rid of then plaque so you need to keep that in mind as well.

[Caroline]

Hi it's a diffiçult one but to be honest I would give it longer,  as it's not a fast working drug from what I've read here and elsewhere, you've struggled for five years with the disease a few more weeks are worth waiting if the side effects aren't bad

Ok let's assume it doesn't work ( although I hope it will work) but if it doesn't  you have other oral alternatives like cyclosporine
Or  the drug I'm on Fumaderm  it's very good and has worked 6years for me
and the new DMF  drug similar to Fumaderm called Skilarence

Ciclosporine
Fumaderm
Skilarence

A great way to learn about the new advances in drugs and snippets of members experiences, that they want to share .....is to subscribe to the free monthly newsletter just Groups

Yes, as Fred says, it is still a bit early to go on the bio’s. However Fumaderm or the new Skilarence, are options. Skilarence is European wide registered so should also be available soon in the UK.
Advantage of Skilarence over Fumaderm would be that it's only DMF, there is no MEF and other stuff involved like with Fumaderm. That makes it a bit safer for your liver and kidneys.
In the leaflet of Skilarence they say that you should take care of your lympho’s, and liver and kidneys. But the last two are more or less standard, there is no indication that it has an effect on liver and kidneys. (Unless of course you already have a problem with them).

[JohnB]

I'm afraid you probably have a bit of a wait yet.
I started off straight into 25mg daily and by week 3 had really bad dry lips. By week 6, peeling hands and feet. I had no signs of any improvement until about week 14, and then it took another 6 months to reduce the Ps down to a couple of blotches around my sock cuff line. I had to take a break just before the 12 month mark due to a persistent headache that needed some investigating.
After about 3 months went back on Acitretin  at 10mg daily to see how it went. No side effects but no clearance either.
My advice is to stick with it. But if you come off the stuff try and tail it off as stopping quickly can give you a nasty rebound breakout.

[PainInTheGuttate]

Cheers for the responses guys, all very helpful! 

I think I'll stick with it for now as I have the pills after all. It was just surprising to see new spots developing when it's not like I have just started the treatment. I expected new patches at the beginning, not now. I am tempted to use some dovobet on some of the more stubborn patches however I am worried that it will simply confuse me as to whether the acitretin is actually working or not.

Let's hope I see some improvement in the next month if not, I'll have a look into some new pills.

[JohnB]

Cheers for the responses guys, all very helpful! 

I think I'll stick with it for now as I have the pills after all. It was just surprising to see new spots developing when it's not like I have just started the treatment. I expected new patches at the beginning, not now. I am tempted to use some dovobet on some of the more stubborn patches however I am worried that it will simply confuse me as to whether the acitretin is actually working or not.

Let's hope I see some improvement in the next month if not, I'll have a look into some new pills.

If dovobet helps I would give it a go for a couple of weeks. Yes it may confuse things but if it helps then that is the goal. If after a couple of weeks after there is no change, then there is nothing lost.
Personally dovobet never did anything for me.

[Will20]

Have gone back on Acitretin today. When I took this drug 10+ years ago it worked and cleared my Psoriasis 99% and I took Acitretin for over 5 years until it just stopped working. Then I progressed onto Methotrexate, and then onto Biological = 6 of these in all.
The latest Biological was Taltz began this in July of this year, I suffered with 5 abscesses and numerous infections: Bladder, Chest etc and my Psoriasis "flared up" worse than ever before??? So, the Dermatologist stopped it a 6 weeks ago. I have started today on Acitretin 10 mg for couple of weeks then up to 20mg for couple of weeks until I reach 30mg and I will have my Bloods monitored every 12 weeks. (I am Type 2 Diabetic and have NAFLD too)

[Fred]

Have gone back on Acitretin today. When I took this drug 10+ years ago it worked and cleared my Psoriasis 99% and I took Acitretin for over 5 years until it just stopped working. Then I progressed onto Methotrexate, and then onto Biological = 6 of these in all.
The latest Biological was Taltz began this in July of this year, I suffered with 5 abscesses and numerous infections: Bladder, Chest etc and my Psoriasis "flared up" worse than ever before??? So, the Dermatologist stopped it a 6 weeks ago. I have started today on Acitretin 10 mg for couple of weeks then up to 20mg for couple of weeks until I reach 30mg and I will have my Bloods monitored every 12 weeks. (I am Type 2 Diabetic and have NAFLD too)

That is interesting Will thank you.

Don't hesitate to start a thread in Prescribed Treatments For Psoriasis about your journey if you wish, it's a good way of tracking your progress and your input could help others.