Management of Vitamin A and Retinoid Side Effects

The term "retinoids" refers to chemical compounds that are derivatives of vitamin A or all-trans retinol. Tretinoin, adapalene, and tazarotene are the topical retinoids used in dermatologic practice. The most important side effect of retinoids is teratogenicity. The most frequent ocular adverse effects due to retinoids include dry eye, conjunctivitis, hordeolum, chalazion, blepharitis, and ocular pain. Eczematous changes due to retinoids include xerosis and even dermatitic changes. Patients with a psychiatric history should be queried at each visit about any changes, particularly about depression, and the retinoid should be discontinued if there is any question about depression or mood change. Retinoids may lead to an increase in the levels of triglycerides and total cholesterol and to a decrease in the high-density lipoprotein, probably by interfering with lipid clearance. Systemic retinoids have various side effects that can be avoided or minimized by appropriate utilization of these agents, both topically and systemically.