From the Guidelines
Tretinoin topical is unlikely to cause elevated AST and ALT liver enzymes. Topical tretinoin is primarily used for acne and anti-aging purposes, and it works locally on the skin with minimal systemic absorption. When applied to the skin as directed, very little of the medication enters the bloodstream, which is why liver enzyme elevations are not typically associated with topical tretinoin use.
Key Points to Consider
- Liver enzyme elevations (AST and ALT) are more commonly associated with oral retinoids like isotretinoin (Accutane), which have significant systemic effects, as seen in the monitoring guidelines for acitretin therapy 1.
- The guidelines for acitretin therapy, as outlined in the British Journal of Dermatology 1, emphasize the importance of monitoring liver enzymes every 2–4 weeks for the first 2 months of therapy and then every 3 months, but this is more relevant to oral retinoids rather than topical formulations.
- If you're experiencing elevated liver enzymes while using topical tretinoin, it's more likely due to other factors such as medications, alcohol consumption, fatty liver disease, or other underlying health conditions.
- It's essential to consult with your healthcare provider about any abnormal lab results to determine the actual cause, as they can evaluate your complete medical history and medication list to identify the most likely explanation for elevated liver enzymes.
From the FDA Drug Label
A dose-related incidence of liver tumors in male mice was observed at those same doses. The FDA drug label mentions a dose-related incidence of liver tumors in male mice, which may be associated with elevated AST and ALT levels.
- However, this information is based on a study in mice and the biological significance of these findings is not clear.
- The label does not provide direct evidence of tretinoin topical causing elevated AST and ALT in humans.
- Therefore, a conservative clinical decision would be to monitor liver function in patients using tretinoin topical, especially if they have a history of liver disease 2.
From the Research
Tretinoin Topical and Elevated AST ALT
- The provided studies do not directly address the question of whether tretinoin topical can cause elevated AST ALT, as they primarily focus on isotretinoin, a different derivative of vitamin A 3, 4, 5.
- However, one study discusses the use of tretinoin (all-trans-retinoic acid) as a topical treatment for photodamaged skin, but it does not mention the effect of tretinoin on liver enzymes such as AST and ALT 6.
- Another study provides information on ALT and AST as biomarkers for liver damage, but it does not specifically address the relationship between tretinoin topical and elevated AST ALT levels 7.
- The studies on isotretinoin suggest that it can cause mild liver enzyme elevation, including AST and ALT, but the relevance of this to tretinoin topical is unclear 3, 4, 5.
- Overall, there is limited evidence to directly answer the question of whether tretinoin topical can cause elevated AST ALT, and more research may be needed to fully understand this potential relationship.