Lipid and teratogenic effects of retinoids.

Teratogenicity and the effect on blood lipids are among the most significant side effects produced by oral retinoids. The effects on blood lipids are limited primarily to an increase in plasma triglyceride levels and a decrease in high-density lipoprotein cholesterol. These can be modified by dietary manipulation or dosage reduction. Although elevated serum triglyceride levels and decreased high-density lipoprotein cholesterol have been linked to coronary artery disease, this has not been the case in patients receiving retinoids for acne. Greater caution must be exercised in patients receiving long-term dosing of retinoids. Teratogenic effects of retinoids include those affecting the central nervous system, heart, and craniofacial structures. Therefore female patients taking oral retinoids must not be pregnant, and precautions should be taken so that they do not become pregnant while under treatment. The time at which patients may become pregnant after retinoid treatment varies with the different retinoids.