FETAL HYDROCEPHALUS AND EAR ANOMALIES ASSOCIATED WITH THE MATERNAL USE OF ISOTRETINOIN

Abstract

A 16 year old mother took 40 mg of isotretinoin (13-cis retinoic acid) daily for cystic acne during the first 130 days of pregnancy. An enlarged fetal head necessitated Caesarian section. The live born infant showed an increased cranialfacial ratio, low set and simplified auricles and an atretic ear canal A.D.. Neurological responses were depressed with poor visual tracking and minimal pupillary constriction to light. At age 5 months there had been no developmental progress. Brain stem evoked responses were abnormal on the right and non-elicitable on the left. An intravenous pyelogram was negative. The CT findings included aqueductal stenosis and an area of cerebral tissue loss in the right occipital region. The right hemicranium was enlarged compared to the left. In rats and rabbits, isotretinoin is similar to vitamin A in producing teratogenic effects involving the ears and brain. Taken together with our observation on the outcome in this human infant, it is suggested that sexually active women under treatment for acne not be given isotretinoin unless an effective form of contraception is utilized and the potential risk to the fetus is described. Should conception ensue, the physician and patient should discuss the desirability of continuing the pregnancy.

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