birth defects are well known and discussed for accutane. if you were prescribed accutane by a dermatologist he should have made it extremely clear.

however, topical isotretinoin derived creams do not effect foetuses, AS FAR AS I KNOW!!

i think the absorption rates through the skin are negligible in comparison to oral treatments.

When my derm prescribed me Differin, she warned me that I can not get pregnant for the above reasons.

Here's a nice summary about topical prescription retinoids and acne:

"The amount of drug absorbed from the skin when using this product is very low; however, there are 4 published case reports of birth defects in the literature associated with topical tretinoin use, which are consistent with retinoid embryopathy. The role of the topical retinoids in these cases remains controversial,¹⁵¹⁸ as 2 prospective studies that examined use during the first trimester of pregnancy with 96 and 106 women did not find an increased risk of major malformations or evidence of retinoid embryopathy.¹⁹,²⁰ However, until data on larger cohorts are collected, women should not be encouraged to use topical retinoids during pregnancy."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114665/

And another one here:

"n 1998 several cases of malformations similar to those induced by oral retinoids were reported in children exposed in utero to topical retinoids (adapalene and tretinoin). The results of two somewhat flawed epidemiological studies were reassuring. (2) New cases of birth defects were subsequently reported in children exposed in utero to topical tretinoin. (3) Epidemiological data are still scant and unconvincing: they neither confirm this risk nor rule it out completely. (4) It is best to avoid using topical retinoids altogether in early pregnancy. Women of child-bearing age must be fully informed of the risks and the importance of effective contraception. This also applies to patients with moderate forms of psoriasis, for which topical tazaroten is indicated."

http://www.ncbi.nlm.nih.gov/pubmed/15981398

There's quite a bit of doubt on the dermatologist's side that topical retinoids cause birth defects in fetuses because of the very tiny amounts of retinoic acid (0.05% to 0.1% or so) and the amount applied (pea-sized), plus it's limitation to the face and considering it's difficult for topicals in general to permeate the skin, not to mention tretinoin's half-life is at most 2 hours. There's some research about tretinoin and systemic absorption, concluding there are "negligible" amounts. Of course, since it's not totally ruled out that it doesn't cause fetal harm, some dermatologists and mothers would rather be "safe than sorry" and minimize any potential risk, no matter how small.

I've been doing some reading on the internet about acne. I came across a website called ScienceOfAcne.com, which has a lot of information that other sites do not. It really goes deeper into the scientific side of things. This website seems to say that most forms of acne share at least one thing in common, and that is overactive sebacious glands or enlarged sebacious glands, or both.

This condition is called "sebaceous hyperplasia," and it is either solely caused by, or mostly caused by, excess of the androgen hormones in the body. Those of us who use retinoids with success have this condition. I am one such individual.

http://scienceofacne...ebaceous-glands

One of the most effective treatments for overactive or hyperplastic sebaceous glands are retinoic acids.

Retinoic acid causes sebaceous glands to decrease in size and reduces their growth rate, resulting in dramatically decreased sebum production. In some cases, treatment with retinoic acid can decrease the production of sebum by up to 90%.

 

That is astounding. It can reduce sebum production by up to 90% and yet I still have oily skin. Imagine how oily our faces would be if we stopped using retinoids. I can't even imagine. My face would nearly be dripping with oil...that is scary...

And if you think that is scary, wait till you read this part, which I have never heard about until now:

http://scienceofacne...ebaceous-glands

The most troubling side effect of retinoic acid is its effect on the developing fetus. Retinoic acid dramatically disrupts normal embryonic development and leads to severe birth defects. For this reason, retinoic acid treatments are tightly controlled in many places, particularly for women.

Tightly controlled, especially in women...hm... As a woman who has been using Tretinoin cream for over a decade, I must admit that I don't recall ever having been told this by a doctor or a pharmacist before. This has me very worried now. Anyone care to comment on this?

And this brings me to my next question. Doctors always seem to want to treat the symptom instead of the core problem. You have overactive sebacious glands, so lets treat the symptom--acne. But why don't we address the underlying issue: the overactive sebacious glands? What is causing them to be overactive in the first place? Research suggests that excessive androgen production plays the leading role. Well, ok, why does the body produce too many androgens? During adolescense, hormones are imbalanced because the body is maturing, but diet and other stressors probably exacerbate the problem. I don't know what people can do to successfully bring their hormones into balance during adolescence--perhaps someone out there has the answer to that one. Or perhaps a high-glycemic diet and sedentary lifestyle fuel the hormonal imbalance.

During adulthood, however, if the body is still making too many androgens, there is a problem. Research suggests that adults who produce too many androgens either have a cancer that is causing it, or their diet is too rich in high-glycemic foods, which spikes insulin and triggers the body to produce too many androgens. Women have even more to be concerned about because we often use birth control pills, which interfere with our body's natural hormone levels and causes imbalances.

http://scienceofacne...ebaceous-glands

The well documented increase in acne rates that occurs during adolescence, particularly in males, is due largely to hormonal changes. The high levels of androgen hormones that begin circulating during male adolescence stimulate the growth of the sebaceous glands. Women with elevated androgen levels can also experience problems with androgen dependent sebaceous hyperplasia. Excessive levels of androgen hormones can be treated with androgen inhibitors, which suppress their effects. Sebaceous glands also appear to respond to non-androgen hormones, like Insulin Growth Factor (IGF), a hormone that has been loosely tied to milk consumption.

Another strike for milk (darnit, I love milk!) So you don't have to be allergic to milk to have a problem with it; it can worsen your acne just because it has IGF in it.

What do you guys think about retinoic acids causing birth defects? Have you ever heard that before?

 

I'll answer "symptom" problem and the milk-acne connection while I'm at it, too:

It's a myth about doctors only treating the "symptoms" -- this is perpetuated on the Internet because people get frustrated that there's no cure and unscrupulous salesmen latch onto this so they could invent vague, muzzy diseases to peddle products. Scientists don't know what exactly causes the "overactive"/elevated hormones because they don't know what specific genetic mutations are behind acne, let alone the ideal "cutoff" serum testosterone range that would definitively cause acne.

This kind of ties into the milk-acne connection: the problem with IGF-1's nature is that it's high in teens and young adults, as they're still developing so IGF-1 levels and acne could purely be a correlation. There hasn't been a ton of research behind IGF-1 serum levels and acne as I've discussed in another post, so IGF-1 and acne is up in the air. But there is no direct proof in a double blind, randomized placebo-controlled study that the hormones in milk can be absorbed, let alone it causing acne.

Yeah I think the jury is out on whether topical retinoids cause birth defects. The manufacturer and doctors are going to rule on the side of protecting themselves and tell you not to use it. However there have been clinical reviews of small sample sizes that found no greater birth defects in groups who had used retinoids during pregnancy than those who didn't. And the amount that is absorbed is very, very low. I think people relate them to Accutane and freak out.