USE IN PREGNANCY AND LACTATION
All systemic retinoids are teratogenic and are absolutely contraindicated during pregnancy and lactation (formerly FDA category X). As discussed above, pregnancy testing is necessary for female patients of childbearing potential before instituting oral retinoid therapy (two tests required in the US for isotretinoin) and then at regular intervals (e.g. monthly for isotretinoin) during its administration. Adequate contraception for at least 1 month before initiation and throughout the treatment course is also mandatory in this patient group. Acitretin requires contraception for 3 years (US) or 2 years (Europe) after cessation of therapy, whereas isotretinoin, bexarotene, and alitretinoin require contraception for just 1 month after cessation of therapy. Although no evidence exists for teratogenicity of topical retinoids in humans, they are nevertheless not recommended for use during pregnancy. Since no dermatologic condition that is known to be responsive to topical retinoids is life-threatening to the mother or fetus, it is wiser to postpone treatment until after delivery, primarily for medicolegal reasons rather than scientific data in the opinion of the authors. As it is not known whether topical retinoids pass into the breast milk, topical retinoid use is generally not recommended during breastfeeding.
Additional figures available in our eBook (see inside front cover for access code).
-
Sato T, Akimoto N, Kitamura K, et al. Adapalene of cystic and conglobate acne with 13-cis-retinoic acid. N Engl J Med. 1979;300:329–333.2. Peck GL, Yoder FW. Treatment of lamellar ichthyosis and
-
Wang Z, Boudjelal M, Kang S, et al. Ultraviolet irradiation suppresses sebum accumulation via the inhibition of triacylglycerol biosynthesis and perilipin expression in differentiated hamster sebocytes in vitro. J Dermatol Sci. 2013;70:204–210.20. Gaikwad J, Sharma S, Hatware KV. Review on character- other keratinising dermatoses with an oral synthetic retinoid. Lancet. 1976;2:1172–1174.3. Brun PJ, Yang KJ, Lee SA, et al. Retinoids: potent of human skin causes functional vitamin A deficiency, preventable by all-trans retinoic acid pre-treatment. Nat Med. 1999;5:418–422.35. Kaya G, Grand D, Hotz R, et al. Upregulation of CD44 and hyaluronate synthase by topical retinoids in mouse skin. J Invest Dermatol. 2005;124:284–287.36. Mukherjee S, Date A, Patravale V, et al. Retinoids in the istics and analytical methods of tazarotene: an update. Crit Rev Anal Chem. 2020;50:90–96.21. Duvic M. Tazarotene: a review of its pharmacological regulators of metabolism. Biofactors. 2013;39: 151–163.4. Chen Y, Clarke OB, Kim J, et al. Structure of the STRA6 treatment of skin aging: an overview of clinical efficacy and safety. Clin Interv Aging. 2006;1:327–348.37. Gniadecki R, Assaf C, Bagot M, et al. The optimal use of profile and potential for clinical use in psoriasis. Expert Opin Investig Drugs. 1997;6:1537–1551.22. Querfeld C, Nagelli LV, Rosen ST, et al. Bexarotene in the receptor for retinol uptake. Science. 2016;353:aad8266.5. Kawaguchi R, Yu J, Honda J, et al. A membrane receptor for retinol binding protein mediates cellular uptake of vitamin A. Science. 2007;315:820–825.6. Wei LN. Cellular retinoic acid binding proteins: genomic bexarotene in cutaneous T-cell lymphoma. Br J Dermatol. 2007;157:433–440.38. Ortiz NE, Nijhawan RI, Weinberg JM. Acitretin. Dermatol treatment of cutaneous T-cell lymphoma. Expert Opin Pharmacother. 2006;7:907–915.23. Quereux G, Saint-Jean M, Peuvrel L, et al. Bexarotene in and non-genomic functions and their regulation. Subcell Biochem. 2016;81:163–178.7. Sorg O, Saurat JH. Topical retinoids in skin ageing:
Ther. 2013;26:390–399.39. Yamauchi PS, Rizk D, Lowe NJ. Retinoid therapy for cutaneous T-cell lymphoma: third retrospective study of long-term cohort and review of the literature. Expert Opin Pharmacother. 2013;14:1711–1721.24. JAMA. Trifarotene (Aklief)—a new topical retinoid for a focused update with reference to sun induced epidermal vitamin A deficiency. Dermatology. 2014;228:314–325.8. Sorg O, Tran C, Carraux P, et al. Spectral properties of psoriasis. Dermatol Clin. 2004;22:467–476, x.
40. Racz E, Prens EP. Phototherapy and photochemotherapy for psoriasis. Dermatol Clin. 2015;33:79–89.41. Lebwohl M. Acitretin in combination with UVB or PUVA. J acne. JAMA. 2020;323:1310–1311.25. Aubert J, Piwnica D, Bertino B, et al. Nonclinical and
Am Acad Dermatol. 1999;41:S22–S24.42. Saurat JH, Geiger JM, Amblard P, et al. Randomized human pharmacology of the potent and selective topical retinoic acid receptor-gamma agonist trifarotene. Br J Dermatol. 2018;179:442–456.26. Vahlquist A, Blockhuys S, Steijlen P, et al. Oral liarozole in topical retinoids prevent DNA damage and apoptosis after acute UVB exposure in hairless mice. Photochem Photobiol. 2005;81:830–836.9. Sorg O, Tran C, Carraux P, et al. Retinol and retinyl double-blind multicenter study comparing acitretin- PUVA, etretinate-PUVA and placebo-PUVA in the treatment of severe psoriasis. Dermatologica. 1988;177:218–224.43. Saurat JH. Systemic retinoids. What’s new? Dermatol Clin.
the treatment of patients with moderate/severe lamellar ichthyosis: results of a randomized, double-blind, multinational, placebo-controlled phase II/III trial. Br J Dermatol. 2014;170:173–181.27. Veit JGS, De Glas V, Balau B, et al. Characterization of ester epidermal pools are not identically sensitive to UVB irradiation and antioxidant protective effect. Dermatology. 1999;199:302–307.10. Tran C, Sorg O, Carraux P, et al. Topical delivery of retinoids counteracts the UVB-induced epidermal vitamin A depletion in hairless mouse. Photochem Photobiol. 2001;73:425–431.11. Wiegand UW, Chou RC. Pharmacokinetics of oral isotret-
1998;16:331–340.44. Harms M, Duvanel T, Williamson C, et al. Isotretinoin for acne: should we consider the total cumulative dose? In: Marks R, Plewig G, eds. Acne and Related Disorders. London: Martin Dunitz; 1989:203–206.45. Rademaker M. Isotretinoin: dose, duration and relapse.
CYP26B1-selective inhibitor, DX314, as a potential therapeutic for keratinization disorders. J Invest Dermatol. 2021;141:72–83.28. Valente Duarte de Sousa IC. Novel pharmacological inoin. J Am Acad Dermatol. 1998;39:S8–S12.12. Torma H. Interaction of isotretinoin with endogenous
What does 30 years of usage tell us? Australas J Dermatol. 2013;54:157–162.46. Amichai B, Shemer A, Grunwald MH. Low-dose approaches for the treatment of acne vulgaris. Expert Opin Investig Drugs. 2014;23:1389–1410.29. Cunliffe WJ, Caputo R, Dreno B, et al. Clinical efficacy and retinoids. J Am Acad Dermatol. 2001;45:S143–S149.13. Nelson AM, Zhao W, Gilliland KL, et al. Neutrophil isotretinoin in the treatment of acne vulgaris. J Am Acad Dermatol. 2006;54:644–646.47. Dessinioti C, Zouboulis CC, Bettoli V, Rigopoulos D.
safety comparison of adapalene gel and tretinoin gel in the treatment of acne vulgaris: Europe and U.S. multi-center trials. J Am Acad Dermatol. 1997;36:S126–S134.30. Gregoriou S, Kritsotaki E, Katoulis A, Rigopoulos D. Use gelatinase-associated lipocalin mediates 13-cis retinoic acid-induced apoptosis of human sebaceous gland cells. J Clin Invest. 2008;118:1468–1478.14. Kane MA. Analysis, occurrence, and function
Comparison of guidelines and consensus articles on the management of patients with acne with oral isotretinoin. J Eur Acad Dermatol Venereol. 2020;34:2229–2240.48. Blok JL, van Hattem S, Jonkman MF, Horvath B. Systemic of tazarotene foam for the treatment of acne vulgaris. Clin Cosmet Investig Dermatol. 2014;7:165–170.31. Darlenski R, Surber C, Fluhr JW. Topical retinoids in of 9-cis-retinoic acid. Biochim Biophys Acta. 2012;1821:10–20.15. Nada HR, Rashed LA, Elantably DMM, El Sharkawy DA.
therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review. Br J Dermatol. 2013;168:243–252.49. Valipour A, Jager M, Wu P, et al. Interventions for the management of photodamaged skin: from theory to evidence-based practical approach. Br J Dermatol. 2010;163:1157–1165.32. Creidi P, Vienne MP, Ochonisky S, et al. Profilometric
Expression of retinoid receptors in hand eczema. Int J Dermatol. 2020;59:576–581.16. Wiegand UW, Chou RC. Pharmacokinetics of acitretin and etretinate. J Am Acad Dermatol. 1998;39:S25–S33.17. Chou RC, Wyss R, Huselton CA, Wiegand UW. A poten- mycosis fungoides. Cochrane Database Syst Rev. 2020;7: CD008946.50. Ruzicka T, Lynde CW, Jemec GB, et al. Efficacy and evaluation of photodamage after topical retinaldehyde and retinoic acid treatment. J Am Acad Dermatol. 1998;39:960–965.33. Lee ES, Ahn Y, Bae IH, et al. Synthetic retinoid seletinoid tially new metabolic pathway: ethyl esterification of acitretin. Xenobiotica. 1992;22:993–1002.18. Gronhoj Larsen F, Steinkjer B, Jakobsen P, et al. Acitretin safety of oral alitretinoin (9-cis retinoic acid) in patients with severe chronic hand eczema refractory to topical corticosteroids: results of a randomized, double-blind, placebo-controlled, multicentre trial. Br J Dermatol. 2008;158:808–817.
G improves skin barrier function through wound healing and collagen realignment in human skin equivalents. Int J Mol Sci. 2020;21:3198.
is converted to etretinate only during concomitant alcohol intake. Br J Dermatol. 2000;143:1164–1169.