TRETINOIN-TOXICITY
----------------------------------------------------


A 39 year old woman with chronic hepatitis C borrowed a friend's Retina A 
cream and applied it for acne. She excoriated her cheeks quit a bit as 
well. 4 weeks later she developed truncal ataxia. When she stopped the 
cream her symptoms of headache ataxia and dysarthria improved. She 
started Retina A (0.025%) 4 weeks later her symptoms re occured to the 
point she required a walker for her truncal ataxia.

Did her pre existing hepatic disease predispose her to have high levels 
of unbound retinoid, causing neuro toxicity or is this another worry fopr 
the practicing dermatologist?

Haines Ely, 
Grass Valley Ca.
----------------