Acitretin embryopathy: a case report.
BACKGROUND
Acitretin is an aromatic retinoid analog of vitamin A. Drugs of this group are well-known teratogenic agents. Nevertheless, acitretin embryopathy has been described only in fetuses.


METHODS
An infant was exposed to 10 mg/day of acitretin from the beginning of pregnancy until the 10th gestational week. At term, the newborn showed the following abnormalities: microcephaly, epicanthal folds, low nasal bridge, high palate, cup-shaped ears, anteverted nostrils, atrial septal defect, and bilateral sensorineural deafness. At 18 months of age, the patient showed microcephaly and neurodevelopmental delay.


CONCLUSIONS
Our patient shows a pattern of anomalies resembling that observed in isotretinoin- and etretinate-exposed children. After ingestion, acitretin is partially converted into etretinate, and etretinate is partially metabolized into acitretin. A similar phenotype would therefore be expected after prenatal exposure to either drug. Moreover, in the present case, teratogenic effects were observed even though the dose was lower than in the previously reported acitretin embryopathy cases. Therefore, we propose that different retinoids, acitretin included, produce only one malformation pattern with variable phenotypic expression.
Línea Salud Fetal, Servicio de Información de Agentes Teratogénicos, Centro Nacional de Genética Médica, Buenos Aires, Argentina. pablo@genes.gov.ar
Pablo
P
Barbero
Vanesa
V
Lotersztein
Ruben
R
Bronberg
Miriam
M
Perez
Liliana
L
Alba
D000015:Abnormalities, Multiple / Q000139:chemically induced*; D017255:Acitretin / Q000633:toxicity*; D004622:Embryo, Mammalian / Q000187:drug effects*; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000139:chemically induced*; D006801:Humans; D007223:Infant; D013723:Teratogens / Q000633:toxicity*
D013723:Teratogens; D017255:Acitretin