The preceding review article on the use of etretinate, a vitamin A analog, seems timely for two reasons: it not only summarizes the beneficial effects in a small group of rare skin disorders in children but also reminds us of the teratogenic effects. The teratogenicity of orally administered high-dose vitamin A and vitamin-A analogs in animals is well known [1,6,7,[9][10][11][12]. With their increased use, it now becomes clear that they are also potent teratogens in man [2][3][4][5]8]. If taken during early pregnancy, spontaneous abortions and severe abnormalities result in the majority of cases. Of 34 pregnancies in which oral isotretinoin was administered, 19 ended in abortions and 10 resulted in malformed children [3]. The congenital abnormalities included defective or absent ears, atretic ear canals, cleft palate, congenital defects of the heart and great vessels, and CNS disruptions such as hydrocephaly, posterior fossa cysts and cortical blindness.
Drs. Traupe and Happle do not mention the major application of vitamin-A analogs, namely for ache. At least in the USA they are widely prescribed for this purpose and have been met with great enthusiasm. Remembering thalidomide, however, I am afraid that the only way to prevent a second drug catastrophe will be to severely restrict or even ban the use of these drugs. It may sound harsh to discard a drug which is so effective against a common scourge. However, it must be remembered that thalidomide was as outstanding a sedative as any vitamin-A analog may be a good anti-acne drug.