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Neurotoxicity Related to the Use of Topical Tretinoin (Retin-A)

Allan L. Bernstein, MD; and Jeanne L. Leventhal-Rochon, MD
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From the Kaiser Permanente Medical Center, Hayward, California. Acknowledgments: The authors thank Hemmige Bhagavan, PhD, Hoffmann-La Roche, Inc., Nutley, New Jersey, for reviewing the manuscript and for providing helpful suggestions, and the Medical Editing Department, Kaiser Foundation Research Institute, for editorial assistance. Requests for Reprints: Allan L. Bernstein, MD, Department of Neurology, Kaiser Permanente Medical Center, 401 Bicentennial Way, Santa Rosa, CA 95403-2192.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(2):227-228. doi:10.7326/0003-4819-124-2-199601150-00006
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Topical tretinoin (Retin-A, Ortho, Raritan, New Jersey), a vitamin A analog, has been used to treat acne vulgaris since 1972 in the United States. Oral [1], but not topical [2], forms of vitamin A have been associated with neurologic complications, and systemic absorption through intact skin is minimal [3]. The package insert of topical tretinoin includes no warning about neurotoxicity [4]. We report a case of neurologic and psychiatric symptoms that resolved after use of topical tretinoin was discontinued.

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