Retinoids

Question 1

What are the contraindications to retinoids?

Answer 1

Hypersensitivity
Women of reproductive age (Acitretin), Pregnancy/lactation (Isotretinoin)
Hypervitaminosis A
Severe dyslipidaemia
Liver disease
Severe eczema

Question 2

What drugs interact with the oral retinoids?

Answer 2

Vitamin A products
Tetracyclines
Alcohol
Phenytoin, progesterone

Question 3

What are the adverse effects of retinoids?

Answer 3

Skin: xerosis, pruritus, retinoid dermatitis, photosensitivity, pyogenic granuloma
MM: xerostomia, cheilitis, epistaxis
Hair: alopecia, telogen effluvium
Nail: nail fragility, paronychia
Eye: dry eyes, blepharoconjunctivitis, blurred vision, photophobia, night vision changes

GI: n/v/d, pancreatitis, transaminitis, toxic hepatitis
MSK: myalgia/arthralgia, DISH, premature epiphyseal closure
CNS: headache/BIH, low mood
Haem: dyslipidaemia, cytopaenias

Hypersensitivity reactions, SJS/TEN

Teratogenicity

Question 4

What two receptors does Isotretinoin bind to?

Answer 4

RAR
RXR

Nuclear receptors

Question 5

What is the MOA of isotretinoin?

Answer 5

1. Reduced sebaceous gland activity
2. Reduced hypperkeratinisation
3. Anti-inflammatory
4. Inhibition of C. Acnes growth

Question 6

What should be discussed with patients prior to commencing Isotretinoin for acne ?

Answer 6

Take with fatty meal
Risk of flare in first 4-6 weeks
See improvement in around 2 months
80% clear with 1 treatment

Question 7

What baseline and ongoing monitoring is required for retinoids?

Answer 7

Baseline
Psychiatric assessment
FBC, LFT, lipids, BhCG

Ongoing
FBC, LFT, lipids at 6 weeks
Consider monthly BhCG

Question 8

What are the indications for retinoids in dermatology?

Answer 8

Acne
Rosacea
Hidradenitis suppurativa
Lichen planus
CTCL
GA
Psoriasis /PPP
Dissecting cellulitis/folliculitis de Calvans
Darier disease, Grover’s disease
Lupus
Sarcoidosis
SCC chemoprophylaxis