Cheilitis retinoic acid

Systemic treatment of 13-cis retinoic acid frequently leads to cheilitis and eye irritations (e.g., unspecific cornea inflammation). Also other symptoms such as headache, pruritus, alopecia, pains of joints and bone, and exostosis formation have been reported. Notably, an increase of very low density lipoproteins and triglycerides accompanied by a decrease of the high density lipoproteins has been reported in 10-20% of treated patients. Transiently, liver function markers can increase during oral retinoid therapy. Etretinate causes the side effects of 13-cis retinoid acid at lower doses. In addition to this, generalized edema and centrilobulary toxic liver cell necrosis have been observed. 

Application of hydrophilic ointment was permitted in those patients who required a topical lubricant. Hydroxyzine hydrochloride was given to a few patients for control of pruritus. White petrolatum was used for the cheilitis resulting from treatment with 13-cis retinoic acid. Oral erythromycin or cloxacillin was necessary to control the recurrent cutaneous infections of 2 patients with Darier s disease and the one with nevus comedonicus. 

After 3 weeks, 15 of the 26 patients were improved, thou none of them cleared completely. A common side effect (after 13-cis- retinoic acid only) was exfoliative cheilitis. In a few cases headaches, diarrhoea, vomiting, and increases in sedimentation rates, transaminases and serum lipids were noted. Schimpf (86 ) treated a group of 33 psoriasis patients with the vitamin A acid derivative Ro 10—9359 (ethyl-all-trans-9(4-methoxy-2,3,6-trimethylphenyl)-3,7-dimeth-yl-2,4,6,8-non-atetraenoate). Furthermore 13 patients with keratoses were treated systemically with Ro 10—9359 the period of treatment varied from 28 days to 9 months. 

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