Toxicity

The adverse effects of retinoids are legion, and are mostly associated with hyper-vitaminosis A (acute or chronic). Fetal malformations, spontaneous abortions, hyperlipidemia (particularly elevated triglycerides), bone abnormalities, skin and mucosal dryness, retinoid dermatitis, pruritus, hair loss, pseudotumor cerebri, arthralgias, myalgias, and abnormal liver function tests (increased liver transami-nases and alkaline phosphatase) are among the myriad potential adverse effects of retinoid therapy (29). Most of the above effects are reversible upon discontinuation of the retinoid, although some serious effects, such as fetal malformations and bone abnormalities, are not. We do not have sufficient case population data to be certain of cause and effect and no true double-blind studies exist. Recently, two classes of nuclear receptors, the RARs (retinoic acid receptors) and the RXRs (retinoid x receptors) have been identified, which are thought to play an important

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