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Neurotoxicity Related to the Use of Topical Tretinoin (Retin-A)
- Allan L. Bernstein, MD; and
- Jeanne L. Leventhal-Rochon, MD
- 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. Requests for Reprints: Allan L. Bernstein, MD, Department of Neurology, Kaiser Permanente Medical Center, 401 Bicentennial Way, Santa Rosa, CA 95403-2192.
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 Report
A 39-year-old woman was healthy except for mild, untreated depression and chronic hepatitis C. She had used topical tretinoin (Retin-A cream, 0.025% tretinoin) for treatment of acne 6 to 8 weeks before visiting the neurology department. The medication was not prescribed by a physician but rather was “borrowed” from a friend. Although the medication caused itching, she continued using it, often excoriating her skin by scratching. The patient reported headache, memory loss, and unsteadiness that interfered with walking, …
This 100-word excerpt has been provided in the absence of an abstract.
