When Alitretinoin Isn't Available, You Still Have Options

Being told your pharmacy can't fill your Alitretinoin prescription is scary — especially when you're relying on it to manage Kaposi sarcoma lesions. The ongoing Panretin Gel shortage has left many patients searching for answers, and one of the most common questions is: What else can I use?

The good news is that there are alternatives. None of them are perfect replacements, and all of them require a conversation with your doctor, but you are not without options. Let's walk through what Alitretinoin does, why it's hard to find, and what treatments your healthcare provider might consider in its place.

What Is Alitretinoin and What Does It Treat?

Alitretinoin is a topical retinoid (a vitamin A derivative) sold under the brand name Panretin Gel. The FDA approved it in 1999 specifically for treating skin lesions caused by AIDS-related Kaposi sarcoma (KS) — a type of cancer that causes abnormal tissue growth under the skin and mucous membranes.

It comes as a 0.1% gel that patients apply directly to their KS lesions, usually two to four times daily. For a deeper look, see our guide on what Alitretinoin is, its uses, and dosage.

How Does Alitretinoin Work?

Alitretinoin is unique because it's a pan-retinoid receptor agonist — it activates all six known retinoid receptors (three RAR receptors and three RXR receptors). This broad activation helps regulate cell growth, differentiation, and programmed cell death (apoptosis) in Kaposi sarcoma cells, slowing their proliferation on the skin.

For more detail on the science, check out our post on how Alitretinoin works.

Real Alternatives to Alitretinoin for Kaposi Sarcoma

The following alternatives have been studied and used clinically for localized Kaposi sarcoma. Every patient's situation is different, so it's essential to discuss these options with your oncologist or dermatologist before making any changes to your treatment plan.

1. Intralesional Vinblastine

What it is: Vinblastine is a chemotherapy drug that, when injected directly into KS lesions (intralesional injection), can cause them to shrink or resolve. It's one of the most well-established treatments for localized KS.

How it works: Vinblastine interferes with cell division by disrupting microtubule formation, which prevents cancer cells from multiplying.

What to know:

• Requires in-office injections, typically every two to three weeks
• Can cause pain at the injection site and temporary skin discoloration
• Has decades of clinical evidence supporting its use for KS
• May be more practical for patients with a small number of lesions

2. Topical Imiquimod (Aldara)

What it is: Imiquimod is an immune response modifier available as a topical cream (brand name Aldara). While it's FDA-approved for conditions like genital warts and certain skin cancers, it has been used off-label for Kaposi sarcoma with encouraging results.

How it works: Imiquimod stimulates the body's immune system to fight abnormal cells. It activates toll-like receptor 7 (TLR7), triggering the production of cytokines that promote anti-tumor immunity.

What to know:

• Applied topically, similar to how Alitretinoin is used
• May cause local skin reactions including redness, swelling, and crusting
• Clinical studies have shown positive responses in KS patients
• More widely available and less expensive than Panretin (typically $50 to $300 with a coupon)

3. Topical Timolol

What it is: Timolol is a beta-blocker primarily used as eye drops for glaucoma. However, the topical gel formulation has shown off-label effectiveness against Kaposi sarcoma lesions in clinical reports.

How it works: Beta-blockers like Timolol may inhibit the growth of the abnormal blood vessels that characterize KS lesions, potentially shrinking tumors.

What to know:

• Evidence comes primarily from case reports and small studies
• Generally well-tolerated with minimal side effects
• Very affordable compared to Panretin (typically under $50)
• Should be considered experimental and used only under medical supervision

4. Localized Radiation Therapy

What it is: Radiation therapy directs focused beams of energy at KS lesions to destroy cancer cells. It's a well-established treatment option for patients with lesions that don't respond to topical treatments.

How it works: Radiation damages the DNA of cancer cells, preventing them from dividing and growing.

What to know:

• Effective for lesions that are too numerous or large for topical treatment alone
• Typically administered over multiple sessions at a cancer treatment center
• May cause skin irritation and temporary discoloration in the treated area
• Best suited for patients who haven't responded to other topical options

What About the Oral Form of Alitretinoin (Toctino)?

You may have heard of Toctino, an oral capsule form of Alitretinoin that's approved in Europe and Canada for severe chronic hand eczema. It's important to know that Toctino is not FDA-approved in the United States and is not approved for Kaposi sarcoma treatment in any country. It should not be considered an alternative for KS.

How to Decide Which Alternative Is Right for You

This decision should always be made with your doctor. Factors they'll consider include:

• The number, size, and location of your KS lesions
• Your overall health and immune status
• Previous treatments you've tried
• Cost and insurance coverage for each option
• Whether the treatment can be done at home or requires office visits

If you'd like to find a doctor who can help with your treatment plan, see our guide on how to find a doctor who can prescribe Alitretinoin.

Final Thoughts

Not being able to fill your Alitretinoin prescription is a real problem, but it doesn't mean you're out of options. Intralesional Vinblastine, topical Imiquimod, topical Timolol, and radiation therapy are all legitimate alternatives that your healthcare team may recommend depending on your situation.

In the meantime, keep searching for Panretin Gel using Medfinder — supply can change quickly, and you may be able to get your original prescription filled sooner than you expect. For more on the shortage situation, see our Alitretinoin shortage update for 2026.