Acitretin, identified by its Chemical Abstracts Service (CAS) Registry Number 55079-83-9, is a highly effective second-generation oral retinoid. This pharmaceutical raw material is primarily utilized in the treatment of severe, resistant forms of psoriasis, a chronic autoimmune condition characterized by rapid skin cell growth leading to thickened, scaly patches. As a synthetic derivative of vitamin A, Acitretin plays a crucial role in dermatological therapy by regulating cell proliferation and differentiation.

The mechanism of action for Acitretin involves binding to nuclear receptors that regulate gene transcription. This interaction induces normal keratinocyte differentiation and reduces epidermal hyperplasia, effectively slowing down the excessive reproduction of skin cells common in psoriatic conditions. Patients typically begin to observe a therapeutic effect within two to four weeks of starting treatment, with maximum improvement usually achieved after approximately twelve weeks. The affected skin either peels off or gradually clears, offering significant relief to individuals suffering from severe symptoms.

Acitretin is particularly beneficial for certain types of psoriasis, including pustular psoriasis, erythrodermic psoriasis, and psoriasis affecting the hands and feet. Beyond psoriasis, it is also occasionally prescribed for a range of other severe skin conditions. These applications include palmoplantar pustulosis, severe hand dermatitis (especially when characterized by very thick and scaly skin), Darier disease, lichen planus, lichen sclerosus, lupus erythematosus, cutaneous T-cell lymphoma, extensive granuloma annulare, severe ichthyosis, and widespread actinic keratoses and certain skin cancers.

Despite its efficacy, the use of Acitretin requires careful consideration due to its potent nature and potential side effects. It is critically important to note that Acitretin is highly teratogenic, meaning it can cause severe birth defects. Therefore, it is strictly contraindicated for use in pregnant women or women who plan to become pregnant within three years following treatment. Women of childbearing potential must adhere to a stringent pregnancy prevention program, including using two highly effective forms of birth control concurrently during treatment and for a full three years after discontinuation. Furthermore, individuals undergoing Acitretin therapy are advised not to donate blood during treatment and for three years afterward, to prevent the risk of exposing pregnant recipients to the medication.

Common side effects associated with Acitretin are often related to its vitamin A derivative nature and typically involve dryness. These can include dry lips, dry nostrils (which may crust and bleed), dry eyes, dry reddened skin, and peeling skin, especially on the hands and feet. Other reported side effects may include generalized hair shedding, increased susceptibility to sunburn, headaches (which should be reported if severe or accompanied by visual problems), and muscle, joint, or bone aches. Liver function and blood lipid levels (cholesterol and triglycerides) must be monitored regularly during treatment, as Acitretin can affect these parameters. Mood changes, including irritability and depression, have also been observed in some cases.

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