Retinoids

Types and differences of retinoids

There are several different types of retinoids. Some come in topical forms, such as gels, creams and topical solutions. Others come in oral (pill) form. They include:

Conditions treated with retinoids

Retinoids are prescribed for a variety of common skin conditions, including wrinkles, sun spots, warts, wounds and severe acne.

Other disorders that may be treated with retinoids include:

• Psoriatic arthritis. A form of arthritis that develops as a complication of the skin disorder psoriasis.
• Cancers. Retinoids can be used to treat cutaneous T-cell lymphoma (cancer of the T cells, often confined to the skin, but able to spread to other regions) by interfering with the growth of tumor cells. They can also be used to treat Kaposi’s sarcoma (a type of cancer characterized by the abnormal growth of blood vessels that develop into skin lesions or occur internally), which commonly affects AIDS patients.
• Lichen planus. A relatively common skin disease that appears as shiny, reddish-purplish, flat-topped bumps with an angular shape.
• Follicular disorders. Disorders of the tiny sacs beneath the skin that produce hairs. These may include folliculitis (infection of hair follicles that occurs on the skin or scalp and resembles acne pimples or crusty sores), rosacea (a skin disorder leading to redness and pimples on the nose, forehead, cheekbones and chin) and hidradenitis suppurativa (chronic disease marked by clogging of the apocrine sweat glands found on certain parts of the body).
• Disorders of keratinization (the process by which skin is replaced following sores or ulcers), such as:
  • Keratosis follicularis (Darier disease). A rare, hereditary condition marked by dark, crusted patches that sometimes contain pus.
  • Actinic keratoses. Small, rough spots on skin that has been chronically exposed to the sun.
  • Pityriasis rubra pilaris. Rare skin condition characterized a group of unusual eruptions that cause red, scaly patches containing dry, plugged pores.
  • Ichthyosis. A condition in which the skin becomes very dry, rough and scaly.

Conditions of concern with retinoids

Retinoids can cause serious side effects. Therefore, patients with any of the following conditions should discuss them with their physician prior to starting retinoid therapy:

• Lymphedema (swelling of the arm or leg)
• Severe liver or kidney disease
• Heart disease
• High cholesterol or high triglycerides
• Depression
• Diabetes
• Bone marrow depression (a slowing down of the part of the bone that produces blood cells)
• Infection
• Cataracts (a clouding or darkening of the lens of the eye)
• Herpes zoster virus (shingles)
• A condition involving phototherapy (therapeutic exposure to light), such as psoriasis
• Alcoholism

Patients should discuss their complete medical history with their physician, including any drug allergies that may rule out retinoid therapy.

differences

Retinoids have the potential for serious side effects. To reduce the chance of side effects, patients should avoid using retinoids during pregnancy and avoid direct sunlight and exposure to artificial ultraviolet light. Possible side effects include:

• Decreased HDL (“good”) cholesterol or increased LDL (“bad”) cholesterol
• Dry mouth and chapped lips
• Runny nose
• Dry nose or nosebleeds
• Eye irritation, including inflammation, dry eyes and crusting of the eyelids
• Increased sensitivity to sunlight
• Intense redness of the skin or skin scaling, peeling and dryness
• Low thyroid function
• Severe birth defects if taken during pregnancy
• Swelling of the arms, feet hands or legs
• Muscle tightness
• Joint pain
• Increased toxicity of insect repellent DEET

Less common side effects of retinoid therapy may include the following impacts to the body:

• Blister formation
• Bone spurs
• Changes to the eye, including cataracts (a clouding or darkening of the lens of the eye), vision changes (e.g., decreased night vision, blurred vision) or yellowing of the eyes
• Hair loss
• Pancreatitis (inflammation of the pancreas)
• Changes to the skin, such as rash, yellowing or peeling of the skin of the fingertips, palms or soles
• Runny nose
• Weight gain

Retinoids may also cause the following symptoms on occasion:

• Diarrhea
• Difficulty sleeping
• Dizziness
• Fever and chills
• Severe headache
• Hoarseness
• Itching (pruritus)
• Lower back or side pain
• Painful or difficult urination
• Loss of appetite, taste or thirst changes
• Nausea or vomiting

Patients taking retinoid medications who experience any of these symptoms should contact their pharmacist or prescribing physician immediately.

There have been reports of patients developing mental health problems while taking retinoids, including depression and psychosis (a condition in which a person suffers from hallucinations and delusions). Suicidal thoughts and actions and violent behavior have also been linked to the drugs.

Patients should contact their physician immediately if experiencing any of the following while taking retinoids:

• Sad mood or crying spells
• Loss of interest in activities formerly found pleasurable, such as eating, work, sex, hobbies and entertainment
• Withdrawal from family and friends
• Changes in sleep patterns, such as sleeping too much or having trouble sleeping
• Becoming more irritable, angry or aggressive than usual
• Significant change in weight or appetite
• Fatigue and decreased energy level

Drug or other interactions with retinoids

While using retinoids, patients should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Patients should not drink alcohol while using retinoids and for at least two months after stopping use.

Some types of retinoids may interact with other types of medication and cause serious side effects. Patients should inform their physician if they are taking any of the following:

• Birth control pills that contain only progestin (“minipills”)
• Vitamin A supplements
• Tetracycline (antibiotic drug used to treat infection)
• Methotrexate (a disease modifying antirheumatic drug [DMARD])
• Phenytoin (anticonvulsant drug)
• Corticosteroids
• St. John’s Wort

Pregnancy use issues with retinoids

Retinoids have been proven to cause severe birth defects when taken by pregnant women or by the mother or father at the time of conception. The drugs have also been linked to miscarriage, premature delivery and infant death. Patients who are pregnant, suspect they are pregnant or plan to become pregnant should not take retinoids. Women who are breastfeeding should also avoid the drug.

Women using retinoids should use two forms of birth control for one month before taking the medications and from one month to three years after treatment to avoid pregnancy. The “mini” birth control pill that contains no estrogen is not considered effective while on this type of medication.

Women using retinoids do not need to use two forms of birth control if they have had a hysterectomy (surgery to remove the womb), have finished menopause (permanent cessation of the menstrual cycle) or practice sexual abstinence.

Child use issues with retinoids

Studies of retinoids have been completed only with adults. No specific information is available for the use of retinoids in children.

Elderly use issues with retinoids

Studies of retinoids have included adults over age 60. Results have shown no difference in the side effects in older patients versus younger adults. However, older adults may be more sensitive to the side effects.