懷孕與哺乳期的使用（USE IN PREGNANCY AND LACTATION）
所有全身性 retinoids 皆具致畸性，於懷孕與哺乳期間為絕對禁忌（過去的 FDA 分類 X）。如上文所討論，具生育能力的女性病人在開始口服 retinoid 治療前必須進行懷孕檢驗（在美國 isotretinoin 需要兩次檢驗），並在投藥期間定期檢驗（例如 isotretinoin 為每月一次）。在此族群病人中，於開始治療前至少 1 個月及整個療程期間採取足夠的避孕措施亦屬強制規定。Acitretin 於停止治療後需要避孕 3 年（美國）或 2 年（歐洲），而 isotretinoin、bexarotene 與 alitretinoin 於停止治療後僅需避孕 1 個月。雖然尚無證據顯示外用 retinoids 在人類具致畸性，仍不建議於懷孕期間使用。由於沒有任何已知對外用 retinoids 有反應的皮膚疾病會危及母親或胎兒的生命，作者認為將治療延後至分娩之後較為明智，主要是基於醫療法律理由而非科學資料。由於尚不清楚外用 retinoids 是否會進入母乳，哺乳期間一般不建議使用外用 retinoids。
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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.