Don't Hesitate to Give Women Topical Retinoids, Expert Says


SAN FRANCISCO — There is no reason to be hesitant in prescribing topical retinoids to women with acne, according to Dr. Hilary E. Baldwin.

While the teratogenic potential of oral isotretinoin is well known, topical retinoids appear to be safe for use in women of childbearing potential, said Dr. Baldwin of the State University of New York, Brooklyn.

According to data from Allergan Inc., which makes Tazorac (tazarotene gel), the normal, endogenous plasma level of retinoids is 6.6 ng/mL. These retinoids come from food sources such as carrots, red peppers, sweet potatoes, and fish, she said at a meeting sponsored by Skin Disease Education Foundation. Oral isotretinoin raises this level to 862 ng/mL, according to the Accutane package insert. In contrast, tretinoin 0.1% cream raises the endogenous plasma level by only 2.9 ng/mL, tazarotene 0.1% gel by 0.14 ng/mL, and adapalene 0.1% gel (Differin) by 0.04 ng/mL, she said.

Several studies looking at women who used topical retinoids during pregnancy found no increase in developmental anomalies among offspring, even though the Food and Drug Administration classifies tazarotene as category X. “My soapbox issue is that whether or not you decide to use it in women who are actively pregnant—and that's a completely different medical-legal concern—you can't ignore half of the world population with acne simply because they happen to have a uterus,” she said. Dr. Baldwin disclosed serving as a consultant to, and being on the speakers bureau of, Allergan and several other pharmaceutical companies. SDEF and this news organization are owned by Elsevier.

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