R. Wilkinson
Mar 6, 1976
Citations
0
Influential Citations
1
Citations
Journal
Canadian Medical Association journal
Abstract
To the editor: It is very distressing to note that the health protection branch of Health and Welfare Canada accepted the recommendation of an anonymous committee of consultants in dermatology and medical genetics that the use of retinoic (vitamin A) acid in the treatment of acne be contraindicated in women during pregnancy and in those of childbearing potential (Can Med Assoc I 114: 412, 1976). This recommendation was made on the basis of evidence accumulated up to 1973, particularly that described by Kochhar' and Shenefelt.2 Since that time retinoic acid has been used in millions of doses in the United States and Canada. It is a superb material when used as directed and has the potential of reducing the cost of acne care substantially. No problems have been encountered to suggest teratogenicity. More to the point, the teratogenic potential of retinoic acid has been evaluated. It was concluded that "the teratogenic risk from topical use of vitamin A acid preparations is minimal and certainly less than that posed by vitamin A containing oral polyvitamin preparations".3 Indeed, the activity of vitamin A in standard prenatal vitamin preparations taken daily was found to be seven times that of retinoic acid used topically.3 For these reasons, and because of the difficult medicolegal position in which the health protection branch and its anonymous committee have placed every physician who has ever prescribed retinoic acid for topical use in this and any other country, I moved at the Apr. 8, 1978 meeting of the section of dermatology of the Academy of Medicine of Toronto that the members of the section request Dr. Morrison of the health protection branch to reconsider the need for a teratogenicity warning on preparations of retinoic acid for topical use. The motion passed unanimously. I also asked for a show of hands of practitioners who were and were not prescribing retinoic acid for topical use. Of the six who were not doing so none indicated that they avoided prescribing the drug because of its potential teratogenicity. In summary, retinoic acid is a valuable drug, our patients need it and most dermatologists in Canada have accepted and prescribed it in the belief that it is nontoxic in the dosage and preparations used. We need Dr. Morrison's assistance, understanding and cooperation and we need it quickly, before the excellent reputation of this drug is smeared beyond redemption.