What are the side effects of oral retinoid therapy?

More than 50 different acute and chronic adverse reactions of oral retinoid therapy have been documented in the literature (Table 56-4). More than 90% of patients receiving oral isotretinoin at therapeutic levels demonstrate cheilitis or xerosis to some degree. A very controversial side effect is the association of inflammatory bowel disease (Crohn’s disease, ulcerative colitis) with oral isotretinoin. There are numerous recent law suits and pending litigation regarding this alleged and controversial association. While one recent study concluded that isotretinoin is not associated with the induction of inflammatory bowel disease, a second study found a weak link between isotretinoin use and the development of ulcerative colitis.

Bernstein CN, Nugent Z, Longobardi T, Blanchard JF: Isotretinoin is not associated with inflammatory bowel disease: a populationbased case-control study, Am J Gastroenterol 104:2774–2778, 2009.


Crocket SD, Porter CQ, Martin CF, et al: Isotretinoin use and the risk of inflammatory bowel disease: A case-control study. Am J Gastroenterol Mar 30, 2010. [Epub ahead of print.]

Table 56-4. Oral Retinoid Toxicity
	ACUTE ADVERSE REACTIONS		CHRONIC ADVERSE REACTIONS
	Mucocutaneous Alopecia (<10%) Cheilitis (>90%) Dermatitis (50%) Pruritus (<20%) Pyogenic granuloma-like lesions in acne vulgaris (rare) Xerosis (>50%) Laboratory Elevated liver function tests (<10%) Hyperlipidemia (25%) Leukopenia (<10%) Systemic Arthralgias (16%) Impaired night vision Mental depression (uncommon) Pancreatitis (rare) Pseudotumor cerebri (rare) Spontaneous abortion Teratogenicity (cardiac, head and neck, CNS)		Mucocutaneous Alopecia, persistent (rare) Dry eyes (rare) Systemic Osteoporosis Premature epiphyseal closure Skeletal hyperostosis