Topical Retinoids Apparently Safe to use during Pregnancy

Pregnancy Outcomes Following First Trimester Exposure to Topical Retinoids : A Systematic Review and Meta-analysis.
Kaplan YC, Ozsarfati J, Etwel F, Nickel C, Nulman I, Koren G.
Br J Dermatol. 2015 Jul 26. doi: 10.1111/bjd.14053. [Epub ahead of print]

Topical retinoids are use in the treatment of acne vulgaris, mainly on the retionnal lesions (blackheads and whiteheads). They are also used in the treatment of wrinkles (rhytids) [along with many other indications (pigmentation, off label uses (keratinization disorders)…]

Oral retinoids (isotretinoin, acitretin, etretinate) are absolutely contraindicated because of their malformative (teratogenic) effects on the fetus. Indeed, retinoids in the body play an essential role in embryogenesis.
Termination of pregnancy is seriously considered if women are taking oral retinoids while pregnant. This is the rationals for the IPLEDGE program in the United States whic requires written consent, two forms of contraception and a negative pregnancy test prior to starting the treatment. (Women can only consider becoming pregnant at least after one month after have stopped taking oral isotretinoin)

In this study:
-the data was retrospectively collected on MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases from inception to December 4th 2014. 654 pregnant women were exposed to topical retinoids during the first trimester and they were matched with 1375 unexposed pregnant women.
-Odds-ratios (OR) were used to suggest compare the 2 groups.

Results
-major congenital malformations (odds ratio [OR], 1.22)
-spontaneous abortions (OR, 1.02)
-stillbirth (OR, 2.06)
-elective termination of pregnancy (OR, 1.89)
-low birth weight (OR, 1.01)
-prematurity (OR, 0.69)

-Despite odds being sometimes more or less than 1
-No significant heterogeneity was detected among the studies for the evaluated outcomes
-The confidence interval always contained the number one suggesting that no significant difference between the two groups could be deducted from this study

Conclusion
-Therefore women pregnant during the first trimester having applied topical retinoids need not worry as this retrospective study suggests.
-However this study cannot justify the use of topical retinoids in pregnancy

Comments
-Vitamin A derivatives play an important role in embryogenesis, but the quantity of topical retinoids making it to the blood stream appears to be small and no effects have been found according to this study.
-In our opinion, regardless of the scientific evidence out there, pregnancy is a very unique period in one’s life cycle and however safe a treatment, moreover a topical one, the decision to apply topical retinoids is not a treatment of primary intention.

In practice, we would reassure the patient that the application of topical retinoids is unlikely to have harmed the baby…but we would discontinue the treatment until after both delivery and breastfeeding.

Warning: the comments are based on an article published in the scientific literature. They are on legal terms an opinion and cannot be relied upon in a patient’s individual decision to undergo treatment – it does not constitute medical advice and for this a decision should be based on the recommendations of YOUR medical doctor (physician)