Adverse reaction to fenretinide, a synthetic retinoid

Abstract

To the Editor. —The widespread and successful use of isotretinoin and etretinate for the treatment of cystic acne and severe forms of psoriasis has established oral synthetic retinoid therapy as an integral component of the dermatologic formulary. However, based on the acute mucocutaneous and systemic toxic reactions as well as the chronic skeletal toxic reactions observed with these agents, the need for a safer systemic retinoid is evident. In preclinical animal testing, the observed toxic effects of therapy with fenretinide, n -(4-hydroxyphenyl) retinamide, (Fig 1) were considerably less than those observed with isotretinoin. 1 In phase 1 clinical studies, in healthy human volunteers using doses up to 600 mg/d for 1 month, the observed clinical toxic effects were limited to mild elevations of aspartate aminotransferase, alkaline phosphatase, and triglyceride values (F. Minn, MD, PhD, McNeil Laboratories, Spring House, Pa, oral communication, 1984). It was concluded that 600 mg/d was minimally