SEVERE LIMB DEFECTS AND CRANIOFACIAL ANOMALIES IN A FETUS CONCEIVED DURING ACITRETIN THERAPY

We describe a 20-week-old fetus with multiple congenital anomalies exp osed to acitretin in the first trimester of pregnancy. Acitretin and i ts ethylester etretinate are both vitamin A congeners; drugs of this g roup are well-known teratogenic agents. Since the marketing of acitret in only one report on human teratogenicity associated with acitretin h as been published. The present male fetus showed severe symmetric anom alies of upper and lower limbs, craniofacial anomalies, ear anomalies, and an atrioventricular septal defect (ASD). Although the craniofacia l anomalies resemble the abnormalities described in classical ''retino ic acid embryopathy,'' limb anomalies were seldomly reported after mat ernal use of vitamin A congeners. However, in laboratory animals limb defects were frequently observed after retinoid exposure in utero. Thi s case emphasizes again that extreme care and precaution are needed be fore prescribing a potentially teratogenic drug to a fertile woman. (C ) 1995 Wiley-Liss, Inc.