Neurotoxicity Related to the Use of Topical Tretinoin (Retin-A)
Authors: Allan L. Bernstein
Journal: Annals of Internal Medicine (1996)

Brief Communications15 January 1996Neurotoxicity Related to the Use of Topical Tretinoin (Retin-A)Allan L. Bernstein, MD and Jeanne L. Leventhal-Rochon, MDAllan L. Bernstein, MDFrom the Kaiser Permanente Medical Center, Hayward, California.Search for more papers by this author and Jeanne L. Leventhal-Rochon, MDFrom the Kaiser Permanente Medical Center, Hayward, California.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-2-199601150-00006 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Topical tretinoin (Retin-A, Ortho, Raritan, New Jersey), a vitamin A analog, has been used to treat acne vulgaris since 1972 in the United States. Oral [1], but not topical [2], forms of vitamin A have been associated with neurologic complications, and systemic absorption through intact skin is minimal [3]. The package insert of topical tretinoin includes no warning about neurotoxicity [4]. We report a case of neurologic and psychiatric symptoms that resolved after use of topical tretinoin was discontinued.Case ReportA 39-year-old woman was healthy except for mild, untreated depression and chronic hepatitis C. She had used topical tretinoin ...References1. Hathcock JN, Hattan DG, Jenkins MY, McDonald JT, Sundaresan PR, Wilkening VL. Evaluation of vitamin A toxicity. Am J Clin Nutr. 1990; 52:183-202. Google Scholar2. Chren M, Bickers DR. Dermatological pharmacology. In: Goodman LS, Gilman A, Gilman AG, eds. Goodman and Gilman's The Pharmacologic Basis of Therapeutics. 8th ed. New York: Pergamon Pr; 1990:1572-91. Google Scholar3. Marcus R, Coulston AM. Fat-soluble vitamins. In: Goodman LS, Gilman A, Gilman AG, eds. Goodman and Gilman's The Pharmacologic Basis of Therapeutics. 8th ed. New York: Pergamon Pr; 1990:1553-71. Google Scholar4. Ortho Pharmaceutical Corporation. Dermatological Division. Retin-A (tretinoin) [package insert]. Raritan, NJ: Ortho Pharmaceutical; 1990 (revised November 1992). Google Scholar5. Biesalski HK. Comparative assessment of the toxicology of vitamin A and retinoids in man. Toxicology. 1989; 57:117-61. Google Scholar6. Bendich A, Langseth L. Safety of vitamin A. Am J Clin Nutr. 1989; 49:358-71. Google Scholar7. Moskowitz Y, Leidowitz E, Ronen M, Aviel E. Pseudotumor cerebri induced by vitamin A combined with minocycline. Ann Opthalmol. 1993; 25:306-8. Google Scholar8. Restak RM. Pseudotumor cerebri, psychosis, and hypervitaminosis A. J Nerv Ment Dis. 1972; 155:72-5. Google Scholar9. Spector RH, Carlisle J. Pseudotumor cerebri caused by a synthetic vitamin A preparation. Neurology. 1984; 34:1509-11. Google Scholar10. Snodgrass SR. Vitamin neurotoxicity. Mol Neurobiol. 1992; 6:41-73. Google Scholar11. Smith FR, Goodman DS. Vitamin A transport in human vitamin A toxicity. N Engl J Med. 1976; 294:805-8. Google Scholar12. Geubel A, De Galocsy C, Alves N, Rahier J, Dive C. Liver damage caused by therapeutic vitamin A administration: estimate of dose-related toxicity in 41 cases. Gastroenterology. 1991; 100:1701-9. Google Scholar13. Vahlquist A. Long-term safety of retinoid therapy. J Am Acad Dermatol. 1992; 27(6 pt 2):S29-S33. Google Scholar14. Hatoff DE, Gertler SL, Miyai K, Parker BA, Weiss JB. Hypervitaminosis A unmasked by acute viral hepatitis. Gastroenterology. 1982; 82:124-8. Google Scholar15. Bigby M, Stern RS. Adverse reactions to isotretinoin: a report from the Adverse Drug Reaction Reporting System. J Am Acad Dermatol. 1988; 18:543-52. Google Scholar Author, Article, and Disclosure InformationAuthors: Allan L. Bernstein, MD; Jeanne L. Leventhal-Rochon, MDAffiliations: From the Kaiser Permanente Medical Center, Hayward, California.Acknowledgments: The authors thank Hemmige Bhagavan, PhD, Hoffmann-La Roche, Inc., Nutley, New Jersey, for reviewing the manuscript and for providing helpful suggestions, and the Medical Editing Department, Kaiser Foundation Research Institute, for editorial assistance.Corresponding Author: Allan L. Bernstein, MD, Department of Neurology, Kaiser Permanente Medical Center, 401 Bicentennial Way, Santa Rosa, CA 95403-2192. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIatrogenic neurologyUse of topical tretinoin and the development of noncutaneous adverse events: Evidence from a systematic review of the literaturePeripheral neuropathy associated with topical tretinoin therapyNeurologic complications of cancer therapyPreclinical models: status of basic research in depressionTretinoin 15 January 1996Volume 124, Issue 2Page: 227-228KeywordsAcneAtaxiaHeadachesLiverNeurologyProteinsRetinoic acidRetinoidsToxicityVitamin A ePublished: 15 August 2000 Issue Published: 15 January 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...