Cutaneous reactions to retinoids

Abstract

Since their introduction in the 1980s, retinoids have been increasingly used for both the topical and systemic treatment of many disorders including, but not limited, to Hyper-And parakeratotic cutaneous diseases, severe acne, keratotic genodermatoses, and chemoprevention of skin cancer. Retinoids affect epidermal cell growth and differentiation, sebaceous gland function, epidermal lipids, and display anti-inflammatory properties. Retinoids have been used both topically and systemically. Today, three generations of synthetic retinoids are available: 1. First-generation (nonaromatic): tretinoin (all-trans-RA), isotretinoin (13-cis-RA), and alitretinoin (9-cis-RA) 2. Second-generation (monoaromatic): aromatic retinoids including etretinate, acitretin 3. Third-generation (polyaromatic): tazarotene, adapalene, and bexarotene. The topical retinoids used at present have marked therapeutic effects on epidermal cell production and desquamation and, although they can only be applied to small areas of skin, they harbor reduced systemic toxicity compared to systemic retinoid therapy. Teratogenicity is the most significant adverse effect of retinoid therapy; however, adverse cutaneous reactions are common, including itching, burning, erythema, and severe skin dryness with a potential Dermatitis-Like reaction sometimes referred to as "retinoid dermatitis." Topical retinoids are rapidly developing at present and seem promising for the future. Novel development of Receptor-Specific retinoids for topical treatment of psoriasis and/or acne may lead to promising new therapeutics. Due to the minimal nature of the side effects associated with topical retinoid use, they should be used as needed, but responsibly, and with the awareness that rare severe reactions have been reported in the literature. At this time, controversy remains as to whether topical retinoids should be available over the counter. In this chapter, we will discuss the potential cutaneous side effects of retinoid therapy.