Oral retinoids and plasma lipids


Address correspondence and reprint requests to: Sergio Fazio, MD, PhD, Cornelius Vanderbilt Chair of Cardiovascular Medicine Professor of Medicine and of Pathology, Immunology and Microbiology Chief, Section of Cardiovascular Disease Prevention, Vanderbilt University Medical Center, 383 PRB – 2220 Pierce Avenue, Nashville, TN 37232-6300, or email: sergio.fazio@vanderbilt.edu.


Retinoids and rexinoids are prescribed for conditions ranging from acne vulgaris to hyperkeratosis to cutaneous T cell lymphoma. Dyslipidemia is a frequent consequence of the use of these drugs, with more than one-third of patients manifesting aberrations in triglyceride (TG) levels. The efficacy of retinoic acid derivatives is linked to their influence on lipid metabolism in the skin, which can impair systemic lipid trafficking and metabolism in some patients. Thus, baseline screening for preexisting dyslipidemia and regular follow-up lipid panels are mandated, especially when powerful agents such as bexarotene are used. Dietary modification, increased physical activity, and weight management are the cornerstones of initial management for mild hypertriglyceridemia, which is a contributor to cardiovascular risk. More severe impairments (fasting TG > 500 mg/dL) warrant pharmacologic interventions early on to reduce the risk of pancreatitis. Retinoic acid derivative action, lipid metabolism, and treatment of incident dyslipidemias are reviewed to empower prescribers in management of adverse lipid effects.